Health Services Amendment Bill
Debate resumed from 28 October.
Mr BARRY O'FARRELL (Ku-ring-gai—Deputy Leader of the Opposition) [6.30 p.m.]: The Health Services Amendment Bill and the second reading speech of the Minister for Health are explicit acknowledgement of the waste, duplication, inefficiency, and cost to taxpayers of the New South Wales health system, which the Carr Labor Government has presided over for almost 10 years. In March this year the Sydney Morning Herald quoted the Minister in a way that gives some evidence of the size of that waste, duplication and inefficiency on the part of the Carr Labor Government at a time when there have been greater stresses, strains and demands upon our health system.
The Minister said that up to $150 million could be saved each year—not through wholesale reform of area health services but, in his words, "by combining the corporate services of the State's 17 area health services". Extrapolating that over the time Labor has been in office, what is clear, what this bill explicitly acknowledges, and what the Minister in his Orwellian language in the second reading speech embraces, is that the Government has wasted almost $1 billion over its life—money that could, and should, have been better used to support doctors and nurses to improve the quality of care in our hospitals and provide patients with the timely access to care they deserve.
Money has never been an issue for the Carr Labor Government, because money is not at the root of its failures in relation to health. The Government has presided over a period in which State revenues have increased by 80 per cent. In 1995 they were $20 billion a year, whereas last financial year they were $40 billion a year. Thanks to the Federal Government and its impact upon the property market, particularly in Sydney, the Carr Labor Government has presided over an unprecedented amount of stamp duty revenue, to the tune of $7 billion over and above what was anticipated.
The Carr Labor Government has never had a shortage of money to direct into the health system. Perhaps it is for that reason that, as the bill and the second reading speech acknowledge, the Government has managed to preside over such waste, inefficiency and duplication in the health system—$1 billion in retrospect, and up to $150 million a year as referred to by the Minister. The reality is that from day one in office the Government failed to ensure that our health system's focus was firmly and squarely on patients. The Government has put bureaucrats ahead of our health professionals and others who work in our hospital system. It has always enjoyed putting bureaucratic structures before the interests of the patients who seek to use our hospitals and health clinics—which is, after all, the basic service that NSW Health is meant to provide.
Under this Government we have seen the bureaucracy grow and grow and grow and grow. I acknowledge that the Government has directed additional funds into health—though the health funding growth rate has not matched the 80 per cent rate of growth of overall revenue during the term of this Government—but it has not ensured that that money has found its target at what we all seem these days to call the front line of our health system. Funds have not been directed to ensuring support for doctors and nurses in our hospitals along with allied health professionals, or to providing patients with the care they need.
What we have seen since Labor has been in office, at least up until the end of 2003—I wait with great interest for the next round of annual reports to be issued—has been a 91 per cent increase in the administrative costs of bureaucrats within the health system. And that is something like double the increase in the costs of those who actually provide medical services within our hospitals. So again we see this Government's priorities: grow bureaucracy before growing the medical profession; put bureaucratic costs up ahead of increasing medical and associated costs for those who staff our hospital system.
I suspect most members of Parliament have a story about their own area health service, but I was a regular visitor to what was then the Northern Sydney Area Health Service, which was housed in Royal North Shore Hospital. What would strike me on my annual visit was that I was inevitably climbing more stairs to see the chief executive officer because more and more floors were being occupied by public servants who were shuffling papers and who were taking money that clearly should have been directed to support doctors and nurses at the front line to provide the care required.
Since becoming the shadow Minister for Health, whenever I visit a hospital, whenever I talk to those involved in the delivery of medical services in hospitals, they all tell the same story: that it has always been easier to create a new area health service position than to appoint a new emergency nurse, to put in place a new triage position, or to appoint an allied health professional at the front end of our hospital system. I challenge the Minister—it may well be his own experience and he may say in his defence that that is what this bill is about—but what we are talking about upfront is this Government's neglect over nine years to ensure that valuable taxpayer dollars were directed to where they were most needed.
This scandal has left our hospitals under-resourced, our health professionals and others at work in hospitals under enormous pressure, and the public enduring less than acceptable delays in accessing treatment, whether emergency or otherwise. This is a government that seems obsessed by structures; this is a government that seems obsessed by the bureaucracy. It is not the approach that the Liberal and National parties endorse or that the Liberal and National parties will embrace when next in office. The Liberal and National parties when elected will be firmly focused on patients, on the quality of care offered by our hospitals and clinics, and on supporting those doctors, nurses and allied health professionals and others at work within those facilities. To achieve that we have made clear our intention to reintroduce local hospital boards.
We believe that that initiative would ensure that health services are delivered where they are needed in a way that gives local communities a real say in what services and resources are available at their local hospitals. It is an approach that is a long way from that of the Carr Government historically, whose approach was about decisions being made by bureaucrats in air-conditioned offices well away from local facilities and well away from local communities. That situation is going to be exacerbated by the structures and approaches outlined and set up by this legislation. We fundamentally reject them.
This morning I was in Dubbo, which will be part of a greater Western area health service of enormous size, and yet we are expected to believe that the myriad local communities that make up that greater Western area health service will all have local input into decision-making. It is simply not real life. It is the sort of Orwellian language that we are starting to hear come through the Minister's speeches as he tries to breach the enormous gulf between his and the Premier's rhetoric, the legacy left to him by Craig Knowles, and the reality that is known to people who work in or who have dealings with the hospital system. As I travel the State, people complain that they feel disconnected from local hospitals, even though it is clear that the Government is happy to accept funds raised by local committees and to use help provided by volunteers. I acknowledge the honourable member for Wagga Wagga, who is in the Chamber. We all know about the sort of community effort supported by the former member for Wagga Wagga which has delivered real benefits to cancer patients in that part of the world.
That is happening across the State. But when it comes to the Government listening to and consulting with local communities, it is all about lip service and keeping people in the dark about how their hospitals are run and about the future of local services. Whether it is in Western Sydney, in the electorate of the honourable member for Mount Druitt, on the North Coast or the South Coast, or in other parts of the State, that repeated criticism is heard from people working within the hospital system, including the pink ladies who work hard to raise the money to buy equipment, who suddenly discover that the equipment has been moved without consultation, without reference to the very people who have provided the funds for it.
The New South Wales Coalition is committed to giving hospitals back to local communities by appointing boards, which will have real clout. We believe that those communities can make intelligent contributions to planning for future services and that under our proposals resource distribution funds would be provided to hospital boards which would allow them to determine the services to be provided and how the monies would be spent. A Coalition government would require hospital boards and district boards to establish strong relationships within the communities to genuinely represent the community's best interests and to link with other health services, including projects which actively promote good health. Hospitals which admit more than 4,500 patients a year would have their own board, except where such a hospital is operated under a single management structure, and district hospital boards would comprise representatives of hospitals which admit fewer than 4,500 patient admissions per year, but which share a community of interest.
Hospital boards and district boards would be structured to ensure that at least half of the representatives were clinicians and others—the very people who provide the services—the other half being members of the community. The health bureaucracy, the general manager and others within our hospital system would be ex officio members. Unlike the current Government, the Coalition believes local communities are best placed to know what services are needed in their regions, and we are prepared to trust those local communities with the important task of planning and decision making in relation to our hospital system.
Trust of individuals and of communities is one of those benchmark differences between the Labor Party and the Liberal Party. That was best epitomised in the Federal campaign where the Federal Leader of the Opposition was obsessed with telling people how they ought to live their lives whereas, clearly, people want to be empowered, want to make decisions about themselves and, in this situation, want to be able to have input into, and control over, how their local hospital is going to operate. The furphy that is often presented by members opposite when we raise this issue is the cost. Given the Minister's admissions in the second reading speech on 6 March, the Government is in no position to criticise anybody for waste, duplication and inefficiency.
These new hospital boards that would be established by a Liberal Government would not be inefficient or costly, or a duplication. In the strong tradition of the volunteering spirit that we see throughout all of New South Wales, participation on boards would be voluntary, although minimum expense allowance would be available to cover the costs associated with board membership. We are not talking about the sort of exercise that we saw occur across the State where three people engaged in a consultative process. I look forward to freedom of information documents, which will reveal precisely how much those individuals were paid for that exercise. We are talking about empowering local communities to make decisions in a way that is both sensible and will deliver better benefits.
As the Minister himself knows, those who operate schools, hospitals or any other enterprise—those who are at the coal-face—know best where inefficiencies and waste exist, know best where needs exist, and are best able to balance those requirements. That is the fundamental difference between our approach to managing health and this Government's approach. Our approach seeks to empower local communities to ensure that hospitals are at the forefront of every person's mind when it comes to delivering health services, in the same way that schools are—there is no area education service or education executive service when it comes to schools—as opposed to the approach of this Government, which, even in this legislation, continues to be about putting this area service monolith between head office, the community and the hospitals but also, and more important, between the source of funding and the application of that funding to vital services within local communities.
The sort of Orwellian language that I have referred to is very striking in the second sentence of the Minister's second reading speech where he talks about the legislation being central to "the Government's planning better health reforms". This is a Government that is always planning for things. This is a Government that is always going to do something. This is a Government that, to some extent, can be characterised by the old nickname "mirror" because they are going to look into it. The Leader of the House has basically traduced, surely, the use of the forward promise or the forward plan. This is a Government that continually talks about planning for better services—not just in health but elsewhere—but has no record of actually delivering those services. That is a real problem, a problem that this side of politics simply will not accept.
The bill seeks to amend two pieces of legislation, the Health Services Act and the Public Sector Employment and Management Act, to give effect to consequential changes arising from the Minister's decision to collapse 17 area health services into eight area health services. Colleagues who follow me will talk in more detail about the implications of those larger area health services. They will highlight the sense of powerlessness that communities feel. They will highlight the gap between the delivery of services on the one hand and the larger area health services on the other, with head office at the further extreme.
The bill seeks to make consequential changes that flow from the Minister's decision on 27 July, principally in three areas. The first is by abolishing the existing area health service boards, which too often seem to become remunerative posts for former Labor Party members of Parliament—and, in the case of one, a former Federal member of Parliament who sat on an area health service board even though he is now a resident of Queensland. That is surely stretching the nose-in-the-trough aspect of Labor politics extremely, even for the Carr Government or those who follow in the footsteps of Graham Richardson, or his mates. I note that the honourable member for Bega has a strong view about the make-up of the former area health service board in his area. We all have a view about the role of the area health service board in relation to Camden and Campbelltown. I will never understand how a board can react to revelations and concerns about the quality of care by picking up the phone and abusing the shadow Minister rather than actually doing its job and trying to find out what was going on. That is precisely what happened to the honourable member for North Shore when she sought to raise concerns about the Camden and Campbelltown situation in the lead-up to Christmas 2002.
This bill seeks to abolish those area health service boards and in effect makes a change to allow what were the chief executive officers of those area health services to report directly to the Director-General of Health. I say again that the focus ought to be upon those who are actually running the facilities or providing the care for people in New South Wales—those who run our clinics, hospitals and services that actually deliver to the people of New South Wales. Second, the bill establishes area health advisory councils. I notice that the latest Star Wars movie is called The Revenge of the Sith, so I should be careful about what I say. I notice that the Minister's release, no doubt written for him by the dark lord, states:
The new Area Health Councils will strengthen the voices of communities in health planning by giving participants direct access to the Area Chief Executive.
Under the old structure—a flawed structured nevertheless—the area health service boards were not advisory and actually had a statutory role to make decisions. Perhaps if they had been better structured they may well have been able to give greater community input, not at the level that the Coalition seeks, but what was the old area health service level. However, the Minister expects us to believe that health councils that are advisory have more power than boards that previously had decision-making roles. It is Orwellian; it is a nonsense; it is the type of spin that this Government is well known for, and it is simply not being bought in the communities any more than the sort of lip-service consultation process that was engaged in.
To be personal again for a moment, as a member within the expanded Northern Sydney and Central Coast Area Health Service footprint, I received my invitation to the consultation that was to occur at Royal North Shore Hospital precisely seven days before it was to take place. I received that by email. I know that one of my colleagues received, if not no notice, less notice. Others are impressed that I actually received an invitation at all. I think that because I am the shadow Minister I at least received seven days notice. The reality is that an advertisement did not appear in the North Shore Times, which is not published as often as newspapers such as the St George and Sutherland Shire Leader and the like in other parts of Sydney. There was no genuine attempt to attract consultation from the community on how these health councils will work because there is no intention that these health councils will have any sort of input. The words are there. They are not backed up by the way in which these health councils will operate, and there is nothing in the legislation to suggest they will.
Thirdly, my favourite part of this legislation—it seems to be a feature of legislation being brought forward by the Government—is where money is saved by establishing another structure. I do not know whether this is a historic feature of the health system, and I do not know whether to blame the Minister for it being a more latter-day announcement. But when we last debated the bill relating to corporate services we saw that an entity would be established before any savings were to be made. So first establish another bureaucratic enterprise to try to cut back on the $150 million a year that we are already wasting in duplication, inefficiency and overlaps! This bill established a health executive service, under which area health service chief executive officers and health service executives will be employed on non-award term contract.
Why is it that, of all the portfolios and administrations, there must be a health executive service? Why can they not be part of the chief executive service, as are so many departmental heads, particularly those revolving departmental heads such as the poor unfortunate Bill Healy, who headed up the small business and tourism portfolio? Or why can they not be members of the senior executive service? There is no education executive service. There is no executive service that applies solely to the transport portfolio. Why do we have to have a health executive service? The reality is that this legislation again demonstrates the Government's obsession with bureaucratic structures and bureaucrats, and its failure to focus our health system fairly and squarely on the need for our hospitals and clinics to deliver services of a high quality in a timely fashion to those who need them.
This evening I do not intend to reprise the failings of the health system. They are well known to those who have access to them and to those who read newspapers and see the news. As I said in another debate last night and earlier this evening, there is an enormous gulf between what the Government claims our health system is like and the reality. There is enormous churn going on. There is enormous disquiet within the system. There are morale problems for which the Government tries to blame the Opposition, but at the end of the day the morale problems relate to the enormous pressure and stress that our doctors, nurses and others who work in our hospital system are under, which is so often related to the lack of resources that are provided. That includes the closure of almost 5,000 hospital beds over nine years.
Too often it relates to what people working in our hospitals and clinics see as their differing treatment compared to that experienced by those who work at the area level and the ease with which they are able to either get a new desk, a new chair or a new position, compared to what happens in our hospital system. But it all comes down to the Government's failure over nine years, admitted by this legislation, to ensure that every dollar allocated to the health portfolio is spent wisely. The Minister said that this bill is an attempt to embrace the principle that we want to stop waste, duplication and inefficiency. We have no problem with that principle, but this legislation simply seeks to repeat the patterns of the past and not put patients first. Again, the Government is obsessed with bureaucrats. When we get to the third reading of the bill I intend to move an amendment relating to the re-establishment of local hospital boards, which Parliamentary Counsel has been able to draft at short notice and for which I am eternally grateful. I indicate to the Minister that we intend to divide on that amendment.
Ms ANGELA D'AMORE (Drummoyne) [7.04 p.m.]: I have great pleasure in speaking in support of the Health Services Amendment Bill, and I congratulate the Government on initiating the reform process that will deliver a better health system. The bill is an important step that will continue to build on the achievements of this Government. The Government has announced a major reform package that will reduce the number of area health services from 17 to eight. As the Minister mentioned in his second reading address, times have changed, and thus the health system must also change. Area health service boundaries were drawn up some 20 years ago, and since then there have been significant changes in the way services are delivered. Changes to population, demographics, technology and transport have all contributed to a fundamental rethink of how our health system is structured. This bill is an historic opportunity for the Parliament to ensure that our health legislation reflects these changes.
The new area health service structure will ensure that our health work force is better distributed—an important component, given the failure of the Federal Government to address medical work force shortages. I note that the Federal Government has shut two faculties of nursing, one at the University of Sydney and one at Orange. I have yet to hear any comment from the Opposition in relation to those cuts. Larger, more integrated area health services will benefit all communities in New South Wales, in particular rural and regional communities. Larger area health services will link areas well served by a specialist medical work force with areas of work force shortage to enhance community access to medical services. This will result in more medical services being provided locally, with a greater pool of specialist resources for patients to tap into. For some time now there has been significant community concern about the operation of area health service boards—real concerns relating to performance as well as the structure of these boards in a rapidly changing health system.
The Government does not believe that the existing board structure is working effectively. In addition, it does not believe that the board structure can adequately carry the New South Wales health system into the future. This outdated structure has generally struggled to successfully engage clinicians, and particularly the community, in health planning and delivery. These problems were identified by the New South Wales Independent Pricing and Regulatory Tribunal in the 2003 report known as "New South Wales Health—Focusing on Patient Care". That is why this bill will abolish area health boards. A new, better structure called area health advisory councils will be established in their place—a new initiative designed to bring together the community and clinicians. The new area health advisory councils are the result of extensive consultation with the community and clinicians by this Government. I am proud of the consultative approach the Government has taken to develop the best model for the advisory councils.
The Clinical and Community Advisory Group established by the Minister for Health has been the strong vehicle for this extensive public consultation. Chaired by the Hon. Ian Sinclair and Ms Wendy McCarthy, the committee has recommended an appropriate model for area health advisory councils. I draw the attention of the House to the extent of such valuable consultation—60 meetings and 160 written submissions, involving 2,300 people in 35 locations across New South Wales. The new area health advisory councils will provide a strong voice for local communities and clinicians in the delivery of health services. Under the new model, area health advisory councils will comprise up to 13 clinicians and community-based consumer representatives. That shows that there will be local input. I understand that the application form for area health advisory councils is currently available on the New South Wales Health web site, and I encourage people to get that application. The Clinical and Community Advisory Group recommends that the Minister for Health be responsible for appointments under the skills-based model. Under this model, the Minister is responsible for appointing clinicians and community representatives with the necessary skills to perform their duties.
The advisory group recommends against the area chief executive being responsible for appointments, and has concluded that this representational model is currently unworkable. Area health advisory councils will be entirely focused on bringing consumer, community and clinician input to the attention of the highest level of area health service management and reporting back to clinicians and the community. The councils will form strong partnerships across the entire area health service. The area health advisory councils will also have strong links with other bodies, such as the new Health Care Advisory Council and the Clinical Excellence Commission. The bill also proposes improved accountability by ensuring that the chief executive is accountable to the director-general, who is accountable to the Minister.
The new structure will see health services managed by the chief executive and supported by an executive management team. I also put on record that it is absolutely important that we continue to engage health staff in our hospitals about these changes to ensure they are part of the process and are comfortable with it. I will continue to consult with the New South Wales Nurses Association and the Health Services Union, which cover the majority of staff in our public hospitals, to ensure I have a direct link with the two unions that cover almost 100 per cent of the work force in hospitals.
I note some comments put forward by the shadow Minister. He continuously plucks out figures suggesting that the Government has shut 5,000 beds. I would like to see the evidence or documentation that proves that. One thing reflected in the statistics is that when the Coalition was in government between 1988 and 1995 it closed 7,000 beds and privatised some hospitals and downscaled other hospitals. I would like to hear the shadow Minister's comments in relation to that. Again, I challenge him to show us the statistics proving that the Government closed 5,000 beds.
This bill is a significant part of the Government's commitment to deliver better health services for the people of New South Wales. It complements the area health service changes that will be effective from 1 January 2005. I am sure all honourable members are aware that this is one of the most significant reforms to health care in New South Wales in the past 20 years. The Government's plan will carry our health system into the future, equipping it for the challenges that lie ahead. I will be discussing these matters with my local nurses, clinicians and senior doctors at Concord Hospital, as I meet with them regularly, as well as our chief executive officer Danny O'Connor. I commend the bill to the House.
Mr ANDREW STONER (Oxley—Leader of The Nationals) [7.11 p.m.]: For many years The Nationals have raised concerns about the quality of public health services and hospitals in regional and rural New South Wales. We have raised the issue of the amount of the health dollar that has gone into bureaucracy as opposed to front-line services. We have suggested restructuring the area health services. However, The Nationals do not agree with the Government's response announced by the Minister earlier this year to effectively centralise a number of area health services out of regional and rural New South Wales, to make area health services much larger and to effectively disenfranchise a number of regional and rural communities. We were arguing for a review of the structure of health in regional and rural New South Wales, our view being that any reduction in the health bureaucracy ought to be diverted to a program of decentralisation, returning some control and decision making to local communities, the way it was under the former Coalition Government.
The Nationals and Liberals have long argued that local hospital boards ought to be restored. That was the way to encourage community input, community pride, community ownership of hospitals, and to ensure that public hospitals throughout regional and rural New South Wales met the needs of the communities they serviced. Sadly, it seems that Labor got only part of the message. It has chosen to centralise. While it has chosen to restructure bureaucracy, with which we do not have a problem, instead of decentralising and establishing local hospital boards, at least for base hospitals and probably a cluster of district hospitals, it has chosen instead to centralise to either major regional centres or city centres.
An example is the amalgamation of the Hunter and New England area health services, which has disenfranchised communities, particularly in the north-west of the State. It has its headquarters in Newcastle, which is remote. The people in Newcastle will not know the local factors that prevail in New England and the north-west. Communities are rightly concerned. They cannot see how they will get the efficiencies, resulting in the management of their area health service becoming remote from them and their communities. They rightly question whether any significant savings will be produced by this restructure. They question whether those savings will go back into front-line health services as promised by the Government.
We have seen nothing to this point to indicate that that is the case. The Minister made a promise that he would reopen a number of beds that have been closed by this Labor Government—nearly 5,000 beds over the past nine years in public hospitals. Earlier this year the Minister promised to reopen 900 beds, and we have seen no evidence of that, certainly not in regional or rural New South Wales. The Nationals have grave concerns with the direction the Government is going with this bill. It is the direction of centralisation, of economic rationalisation, certainly not encompassing local communities in the management and direction of their local hospitals, as was the case in the past. The Nationals have concerns that as a result of this program of centralisation of the management of health services we will see significant job losses in towns like Broken Hill and Tamworth. We are concerned that the promised savings that should go to front-line health services have not been realised.
I will now deal with the three major sections of the Health Services Amendment Bill. The first is to abolish area health service boards. On the surface, The Nationals have no problems with the abolition of the existing area health boards, because they contain a number of party political appointments. That was particularly the case on the mid North Coast where my electorate is located. A number of Labor Party hacks are on that board. They did not fully represent the community, and there were concerns about that. As I said, rather than just abolish area health service boards, local hospital boards should be restored so we get the benefit of the ownership and pride they take in their local hospitals.
Other instances are the hospital auxiliaries, the pink ladies, and the many service clubs in country towns that have always supported their local hospitals. They have raised funds and bought beds and medical equipment, and they have been depressed by the direction taken by the area health services by accepting that money but perhaps spending it on equipment in another hospital in the area covered by that board. We would say yes to abolishing the area health service boards provided the Government restores local hospital boards. This Government is not proposing to do that. It leaves a huge gap in community input.
The second major provision of the bill is to establish area health service advisory councils. Presumably this replaces the area health boards, but they are no replacement for local hospital boards. They are not even an adequate replacement for area health service boards because they are simply advisory councils. They would have no input into decisions per se. It would be a claytons form of consultation where they would feel they are being listened to but they would have no guarantee that the advice of the people on those boards will be accepted, because they simply do not have a direct role in decision making. The Nationals are also concerned about nurses being excluded from having a say on the health advisory councils.
The third provision of the bill is to establish a health executive service, which provides for senior executive service [SES] look-alike health executives. This executive service will provide a way to escape the normal scrutiny of SES positions that are located in other government departments. The provision establishes another form of bureaucracy. As I said earlier, we have no guarantee that savings are going into front-line services. We have not seen that happening. In fact, this bill creates yet another bureaucracy at the senior level which escapes the normal standard of scrutiny that is expected in New South Wales. The Nationals join with the Liberal Party in opposing the bill. The Coalition will seek to have the Government consider an amendment to introduce local hospital boards because we firmly believe that is what communities want. The local hospital boards worked in the past but, sadly, the Labor Government dismantled them. They provided a valuable contribution to our public health system in New South Wales.
Mrs BARBARA PERRY (Auburn) [7.21 p.m.]: I have great pleasure in supporting the Health Services Amendment Bill. I commend the Minister for Health for this significant reform within the health system. Before I delve into the content of the bill, I want to reply to a couple of matters raised by speakers on the other side. The shadow Minister for Health, the Deputy Leader of the Opposition, spoke about the closure of beds. Between 1988 and 1995 the Coalition closed 7,000 beds, and it closed, privatised and downgraded 30 hospitals, one of which was Lidcombe hospital. That was a sad day for my local community, which fought very hard to keep its beautiful hospital open.
Further, the Leader of The Nationals said that nurses would be excluded from having a say on the area health advisory councils. That is incorrect. He is under some misunderstanding in that regard. The Minister specifically said that clinicians would be involved, which includes doctors, nurses and allied health professionals. Nurses will not be excluded from having a say or being part of the process. Clearly, one of the features of the bill is directed at giving health professionals—including nurses and clinicians—and health consumers and other members of the community a greater say in how the State's public health care system delivers health services at both the State and local level. Therefore, this bill is an integral part of the Government's reforms to the New South Wales public health system.
The Planning Better Health reforms will deliver a more efficient health system. As we know through other legislation in this Parliament, 17 area health services will be amalgamated into eight larger areas to reduce administrative duplication and direct more resources to front-line clinical care. The reforms will also enhance the building of better clinical networks and academic and teaching links, and improve the distribution of the work force. The latter part of the reforms is of great importance to the district hospitals in my electorate—Bankstown, Lidcombe and Auburn. Such a measure will increase the expertise of the district hospitals and, ultimately, benefit the community.
One of the key changes made in the bill is the abolition of area boards and their replacement by a chief executive with the support of an executive management team. There will be clear lines of accountability from the chief executive to the director-general, and in the process accountability through proper governance processes. The other key changes include the implementation of area health advisory councils made up of clinicians and community-based consumer representatives and the establishment of a health executive service. The key change I wish to focus on is the implementation of the area health advisory councils, which is relevant to my local area. The advisory councils will be established to give doctors, nurses, allied health workers and the local community more say in the provision of local health services. The councils will advise the area chief executive officer and are intended to strengthen clinical and community involvement in the planning and delivery of health services.
The establishment of the area health advisory councils is intended to build on existing consumer and community participation structures at a local level, not to replace them. That is a key feature and intention in the whole process. This reform is most relevant to my electorate because of a significant group in my local area called the Auburn District Community Health Advisory Council [ADCHAC]. ADCHAC, which was established 20 years ago in the Auburn area, is probably the pre-eminent community participation group and consumer advocate body. It works to promote community health in the Auburn local government area. The group is currently made up of extremely committed people. President Barbara Curtin has been a tireless worker on health issues in the Auburn area. Eva Cardwell and Lee Rossi are two formidable women who have lived locally virtually all their lives and have been with ADCHAC from its formation 20 years ago. They are the longest-serving members of the group.
The committee members come from various walks of life and their experience is invaluable. I would like to place their names on the record: Maureen Threlko, Doreen Stanmore, Jaya Balendra, John Geoghan and Kim Appleby. The health workers in my local area regularly provide reports on the progress of health services to the committee. But the committee does not just receive reports about the health services in the area; it is proactive. Over the past five years it has had some outstanding achievements, two of which I will refer to.
ADCHAC is well recognised for the immunisation campaign and kit it produced a few years ago, which was used to promote immunisation in the local area. The kit was distributed through mothers groups, early childhood groups, playgroups and doctors offices, and various community health nurses used it in their programs. To my knowledge the kit is the only one produced for local needs in any local area. Another wonderful achievement of ADCHAC in the past five years is the adolescent asthma program. The program was instigated by ADCHAC, together with Dr Smita Shah. Dr Shah was also integral to the immunisation campaign. Because Auburn is a diverse cultural community, it is important that local health groups run these important health-specific campaigns, such as immunisation and asthma awareness, in various languages to educate the community.
The adolescent asthma program commenced in Auburn in the local high schools and primary schools. This well-recognised program was then used in rural areas and has now gone national and international. Again, I do not know of any other program that has been undertaken on a local basis in this way. ADCHAC is an example of effective consumer and community participation. The new area health advisory council will no doubt benefit from the experience of ADCHAC, which has been servicing the Auburn health community for 20 years. It is encouraging to note that the establishment of area health advisory councils will seek the view of bodies such as ADCHAC and build on their experience. I am sure there are similar bodies of significance in other local areas.
Further, the area health advisory councils will advise the chief executive officer on how best to support, encourage and facilitate the organisation's community health service consumer and clinician involvement in the planning of health services in local areas. This great reform will continue to build on and enhance our health system. A comment was made earlier that this is a government that always has the concept of forward planning, but it is important that changes are brought about to evolve with the community generally. That is what the reform package is all about. I am proud to commend the bill to the House.
Mr DARYL MAGUIRE (Wagga Wagga) [7.30 p.m.]: I have been watching the progress of the bill with interest and waiting for it to arrive in the House for debate on behalf of my community in the electorate of Wagga Wagga. The bill amends the Health Services Act to provide that area health services are to be governed by the chief executives, and consequentially to abolish the existing area health boards; to provide for the establishment of area health advisory councils to give advice with respect to certain matters affecting the operations of area health services; to provide that statutory health corporations may be governed by their chief executives as an alternative to their being governed by health corporation boards and to enable the Governor, by order published in the Government Gazette, to change a statutory health corporation's governance from one form to another; to provide for the establishment of advisory councils to give advice with respect to matters affecting the operations of statutory health corporations that are governed by their chief executives; to provide for the establishment of a Health Executive Service, similar to the Senior Executive Service under the Public Sector Employment and Management Act; to enact savings and transitional provisions consequent on the other amendments made by the bill; and to make other minor, consequential and ancillary amendments.
The Deputy Leader of the Opposition, the shadow Minister for Health, indicated that we would move amendments to the bill. From the time the amalgamation was announced on 27 July the community I represent in the electorate of Wagga Wagga and those around my electorate—Murrumbidgee, Burrinjuck and Albury—have been concerned about the process. Wagga Wagga City Council convened a meeting with representatives from Albury City Council, the Riverina Regional Development Board, the Riverina Division of General Practice, the Riverina Eastern Regional Organisation of Councils, which includes 13 local councils, and the Riverina Institute of TAFE to discuss the implications of the proposal. In a press release the group unanimously opposed the amalgamation proposals and agreed to develop a proposal for the establishment of a ninth Riverina Area Health Service to provide health services to the Wagga Wagga, Albury and Griffith communities. The spokesperson for the group, Nancy Piercy from the Riverina Division of General Practice, said:
The Riverina-Murray region is a dynamic region with a creative health plan that has just been finalised (by the GMAHS). The region is one of the few across the state that has managed to develop a plan that has been endorsed by the community, health professionals and has been submitted to the health department. We have an obvious community of interest between the three major centres in the Riverina-Murray and the surrounding communities, and we believe a better proposition for improved delivery of health care to our communities is to establish a 9th area health service.
The Premier came to Griffith and categorically ruled out the establishment of a ninth area health service. The task force response is, "We can live with that. We can live with eight, so long as it is based on the Riverina-Murray." The press release states:
We fail to understand how services will be improved in our region by the proposed merger and are surprised that the Government is amalgamating areas when the Independent Pricing and Regulatory Tribunal (IPART) recommended against mergers.
Our proposal will support the IPART findings, will deliver improved financial performance and will generate better health outcomes for our communities.
Doctors from the south of the area met and issued a press release, which states:
The Wagga Wagga Base Hospital Medical Staff Council met Southern health administrator Stuart Schneider last week and said it feels obliged to warn the community about its concerns.
In a statement, the doctors said they have been given no guarantee there will be no loss of clinical services in the city as they currently stand.
The doctors have urged community members to attend meetings to discuss the changes and the implications for health service provision.
Clearly our community is concerned about the amalgamation of the Greater Murray Area Health Service and the Southern Area Health Service, which, when combined, will create a land mass the size of Victoria. When the Minister announced amalgamations he also forecast a consultative process that would include Wendy McCarthy and Ian Sinclair, who is no stranger to this place and who is well regarded in country circles. The process was put in place, but before we had an opportunity to have a meeting I note a newspaper article on 26 August in which the honourable member for Monaro stated:
I lobbied the Minister hard for this outcome, and this will ensure Queanbeyan retains the State Government jobs that are obviously economic contributors for the region.
Mr Sinclair and Ms McCarthy convened our meeting, which I attended together with about 150 others. An article in the Daily Advertiser under the headline "Anger over health services merger" states:
A FIERCE rejection of the state government's planned restructurings of health administration at a public meeting in Wagga on Saturday may influence health minister Morris Iemma to rethink his plans.
About 150 people attended the meeting, and of 25 speakers, 20 either flatly rejected the model or included criticism of it in the submissions.
Co-chairman of the meeting Wendy McCarthy later described the meeting as the most aggressive held so far and said she was disappointed in the approach of some people.
"We have a politicised, bastardised system being foisted on us," said Wagga general surgeon, Henry Hicks.
"The worst thing for your community is not to have a voice in the future," Mr Sinclair said.
But the chief executive officer of the Riverina Regional Development Board, Peter Dale, said the consultation meeting was putting the "cart before the horse".
"How can we come here to assist you move down a path none of us accept as legitimate?" he asked.
The process was nothing short of an absolute disgrace. It was by invitation only. It was not advertised in the local Daily Advertiser or on the television. Invitations were sent to people the department felt should be invited. It was only after I found out about it that I encouraged the community to attend. The Division of General Practice was not informed that the meeting was to be held. I label that an absolute disgrace. When people got to the meeting they found a document on their chairs, which asked for input into how the structure would work and how the information flow would come back to the chief executive officer and the Minister. They were asked to give an opinion within one hour. It was a keystone cops mentality and operation. The clear message from the meeting to the Minister was: "We do not agree with what you're trying to do. We agree that you need to save money. We agree that you need to cut waste and get rid of mismanagement. No-one could disagree with that. We must put resources at the coalface: we all want that. But the clinicians and the health specialists disagree with the way you have gone down this path because it does not reflect the IPART findings." I will come back to that point.
It was suggested at the health advisory council meeting that the honourable member for Monaro had indicated by his comments that he had influenced the Minister's decision to relocate the Greater Southern Area Health Service headquarters to Queanbeyan. My community, which had not had the opportunity of discussing the issue with the Minister, was very concerned about those comments—and rightly so, if they are true. The comments were made by the honourable member for Monaro on 26 August 2004. On 29 July the Daily Advertiser reported that a spokesman for the Minister rejected any suggestion that politics had played a role in placing the Greater Southern Area Health Service in Queanbeyan. In an estimates committee hearing the Minister was questioned about the restructuring by a member of the Legislative Council as follows:
The Hon. ROBYN PARKER: Returning to an earlier question, we were talking about the new area health services and the composition of those. You outlined some principles in which you established those areas. I wonder if you could give us an assurance that those new structures were made on the basis of those principles and not on the basis of politics?
Mr IEMMA: They were made on those principles, including existing area health service boundaries, the need to remove some artificial barriers that boundaries had created to clinical services. That was also part of the consideration.
The Hon. ROBYN PARKER: So politics did not come into it at all?
Mr IEMMA: No.
I acknowledge the presence in the Chamber of the honourable member for Monaro. I hope that during his contribution to this debate he will either confirm or deny that he influenced the Minister. The Minister says he did not, the Minister's spokesman said he did not, but the honourable member for Monaro says he did. I think the honourable member for Monaro should explain. The Wagga Wagga community compiled a submission which basically acknowledged the reasonableness of the need for efficiencies so that resources can be directed to the coalface of the provision of health services, where they will do the most good. The Independent Pricing and Regulatory Tribunal [IPART] undertook a review and its recommendations contained many initiatives. As the Wagga Wagga community's submission points out, the message being sent by the IPART was that health outcomes may be improved without the need to amalgamate area health services. The review referred to better performance through clearer roles and accountability, and all those factors are important. [Extension of time agreed to.]
The IPART review and its recommendations are generally endorsed by communities across the Riverina-Murray region. The outcomes that have been identified by the IPART to deliver improved health services are planning that is focused on patient needs, better quality care and patient safety, more integrated service delivery, stronger structures for clinician and community participation, more equitable health outcomes and more effective funding arrangements, better performance through clearer roles and accountabilities, more efficient support services, a more integrated performance measurement system, and a more sustainable health work force.
The submission from the Wagga Wagga community made some observations which contradict the IPART recommendations. One of the IPART's recommendations was for stronger structures for commission and community participation. The strong message from the IPART is that improved health outcomes will be achieved when clinicians, the community and the department participate and act co-operatively. The submission points out that a fundamental requirement for implementing this recommendation is effective consultation between all parties.
Clinicians and community participation, as recommended by the IPART, needs to occur at all stages of the delivery of health services, including the determination of an appropriate administrative structure for the health service. In that context, reference has been made to the re-establishment of hospital boards—something my community wants. The people of Wagga Wagga want to be involved with its local hospital, as they used to be. They want to take part in its activities, support the hospital, and raise funds for its services. The people of my community are passionate about the delivery of health services within their region, but the restructured and relocated area health service will dissipate support for the very outcome that is sought to be achieved.
The IPART also recommended better performance through clearer roles and accountabilities. It focused extensively on the need for clarity of roles between the department and the area health services, and on the need to make sensible recommendations regarding mechanisms and structures to ensure accountability at the department level and the area health service level. The IPART did not, however, recommend that the amalgamation of area health services be implemented. In fact, the tribunal went to some lengths to recommend against boundary changes and area amalgamations. It stated:
The health system has already undergone significant change since 2000, and the reforms recommended by this review will result in further substantial change. Adding an extensive review of Area boundaries and program of Area amalgamations to the reform agenda is likely to be disruptive, and negate some of the gains to be made in other parts of the system. Indeed, a degree of certainty in the overall framework for the next five years is highly desirable.
That is not happening. The IPART went on to state:
IPART believes that the [Health] Department, in consultation with the new Health Care Advisory Council, should review the number and boundaries of the AHS's in the medium term. The Tribunal considers that there is not a strong case for a system-wide boundary review at present. However, this does not preclude it considering any "one-off" amalgamations, such as Western Sydney and Wentworth ...
The submission concurred entirely with the tribunal's view that the proposed amalgamation will be disruptive and will negate gains. Moreover, the community argued that gains were already being made in the region. My community had already implemented a plan that was delivering outcomes for the Greater Murray Area Health Service. Reference has been made to corporatisation, and the Greater Murray Area Health Service has already done that. Corporatisation of our area health service was already delivering savings.
The restructuring and relocation is expected to save $3 million, but at no time has the Minister or any of his bureaucrats told my community how many hospital beds will be reopened, how many nurses and clinicians will be employed, and how the infrastructure will be improved. There has not been a word from the Minister other than claims of good planning. While this Government is good at planning, it is very slack at delivering. Clinicians are concerned that the Greater Southern Area Health Service is another Campbelltown and Camden situation in the making.
Although I wish to make other points based on the submission, sadly I am limited by time. I have already been granted an extension of time, and if the House would be kind enough to grant me a further extension I would gladly accept it. I have numerous documents that have been produced by people who have been involved in community health services for many years and who are committed to the delivery of high standards of health services in the southern New South Wales region. Their expertise is second to none. Wagga Wagga has built up a clinicians base that needs the enhancement of a regional referral centre as well as infrastructure in Griffith, and I acknowledge the presence in the Chamber of the honourable member for Murrumbidgee.
The people of Wagga Wagga want the Government to put its money where its mouth is and build a Wagga Wagga base hospital, but not one word has been said about the improvements that will be effected by the so-called savings that are expected to be made as a result of the relocation and restructuring of the southern region's area health service. Sadly there is not sufficient time for me to complete my speech and discuss in full the community's submission to the IPART. However, for the edification of honourable members, I will table the submission.
Mr Tony Stewart: How much time do you need?
Mr DARYL MAGUIRE: I need more time to concentrate on this important issue. The Wagga Wagga community wants local hospital boards to be re-established but, more importantly, everybody wants to see an improvement in the delivery of health services in the southern region. The bill will never achieve that. The Government has never bothered to allay community fears about a loss of health services. I do not blame clinicians or people in my community for being upset about the way the bill has been managed.
Mr STEVE WHAN (Monaro) [7.48 p.m.]: It is with pleasure that I support the Health Services Amendment Bill. Already, positive outcomes are emerging from the new area health service structures that have been announced. In the Monaro electorate, perhaps the most positive outcome has been the permanent appointment of Stuart Schneider as the Chief Executive Officer of the Greater Southern Area Health Service. That is a very good outcome for the whole southern region of New South Wales. Fundamentally, this bill is about whether people want desks or beds in their hospitals. When the restructuring was announced, the Australian Medical Association stated that, basically, restructuring is either about the provision of services or money being spent on administration. The Opposition's proposal to re-establish hospital boards is nothing more than a populist stunt. It is a con that is being perpetrated upon the people of New South Wales—a back to the future joke that will do nothing to improve the delivery of health services in New South Wales.
Imagine hospital boards in regional New South Wales setting out to compete against each other, to recruit very limited available specialist services, instead of working together to obtain better specialist services and share services in the region. That is an inevitable result of putting in place smaller boards, because they would have to use their limited resources to compete for specialists to work for them. Hospital boards have no place in 2004; they simply do not represent good management of the health system. The Opposition's proposal would cost millions of dollars to implement; that is millions of dollars in increased bureaucracy rather than in savings. In 1988 hospital boards existed, including at Queanbeyan hospital.
The Coalition then came to office and did what we knew it would do: it sacked all the hospital board members it believed were sympathetic to the Labor Party and appointed National Party stooges in their place. It then went about tearing the boards apart and reducing their work. We have heard amazing hypocrisy by the Opposition about hospital boards, nothing more than a populist stunt in an attempt to con people in Queanbeyan, Dubbo, and other rural areas into thinking that it is interested in delivering health services; quite clearly it is not. Tonight the Opposition revealed that it had lied during the last election campaign when it promised to give Queanbeyan a hospital board. Tonight the Opposition spokesman said that a Coalition government would appoint boards to hospitals that handled more than 4,500 admissions each year.
Under the Opposition's proposal Queanbeyan would not get a hospital board; it would be part of a regional proposal—a totally undefined regional proposal. What would that be? How big would it be? Where would it be located? No-one knows, because the Opposition has not given those details; it is more interested in a populist stunt. Currently there are two hospitals in the Bega electorate that service the Monaro area: Bega District Hospital and Pambula District Hospital
Mr Andrew Constance: Both in my electorate.
Mr STEVE WHAN: I said they were located in Bega. The honourable member for Bega should listen for a change. The medical fraternities at those two hospitals are leading a very sensible debate about the future of the hospitals. They have put forward the idea of building a single new hospital in the long term—a very sensible idea in my view. That new hospital would service a lot of people in the Monaro. The resource initiatives introduced by the Minister for Health has delivered further orthopaedic services to Monaro residents. Imagine if we suddenly went back to the future and had two communities competing against each other to defend their existing hospital services. Instead of getting a new service that delivers more, we would be stuck in the past of defending an old hospital with outdated limited services.
The Opposition talks about hospital boards as if each hospital has its own board. People are interested in hearing about better hospital services; they are not interested in hearing the Opposition talk about the politicisation of hospitals. Tonight we heard the oft-repeated claim by the Opposition of 5,500 beds being lost. Recently the Auditor-General released a report on bed blockage that showed that figure to be an absolute lie. Tonight the honourable member for Wagga Wagga fundamentally disagreed with the Opposition spokesman about hospital policy. The shadow Minister said the area health services set-up prior to amalgamation was a waste of money, and he accused the Government of wasting money for many years.
The honourable member for Wagga Wagga said he wanted to see the two area health services remain as they currently are; that is, the Greater Murray in Wagga Wagga and the southern in Queanbeyan. He said the Opposition wanted to establish a ninth health service and maybe the Opposition would accept that that will not occur and that they would be happy with the current area health service as long as the headquarters was in Wagga Wagga. I wonder what the Batemans Bay constituents of the honourable member for Bega would think of that. I wonder what the people of Bega would think about that—something the honourable member for Bega has been silent on. Queanbeyan is the logical place for the headquarters of the health service because it is the biggest city in the area and has the best communications links. Each day there are in excess of 30 return flights to Sydney, as well as flights to Albury from Canberra airport..
Madam ACTING-SPEAKER (Ms Marie Andrews): Order! I call the honourable member for Wagga Wagga to order.
Mr STEVE WHAN: Queanbeyan is an excellent location for a health service headquarters, because it has access to the services and facilities needed to run a decent administration. In southern New South Wales a massive scare campaign, an incredibly dishonest scare campaign, has been run about the lie of the loss of clinical services. It is an absolute disgrace to hear the honourable member for Wagga Wagga telling his community that there could be "a loss of clinical services in Wagga Wagga". That is a disgraceful misrepresentation of what this is all about. Clearly this is all about taking money out of administration and putting it into front-line delivery of health services. That is what people in regional New South Wales want.
Mr Daryl Maguire: The CEO said that.
Mr STEVE WHAN: The chief executive officer of the Southern Area Health Service has spoken to the people of Wagga Wagga and told them how good the services will be, and I am very confident he can deliver. Over the next months the community will be involved in the development of the clinical services plan. That is a terrific opportunity for communities to contribute. Again, I return to the populist stunt about hospital boards. The Opposition wants to pour millions and millions of dollars in extra administrative money into hospital boards; that is part of the voodoo economics of the Opposition. I keep a tally of the commitments by Opposition members, and it is up to $8 billion in tax cuts already. I have heard the honourable member for Lismore say the Opposition would abolish payroll tax. I have heard the honourable member for Bega say the Opposition will abolish land tax.
Yet tonight the Opposition has said it will spend even more. Will it be $20 million or $40 million extra just on administration so it can pull this populist stunt by saying, "Remember the nostalgia of hospital boards?" But hospital boards have nothing to do with the delivery of good health services. People in regional New South Wales want good health services, not the populist stunts that the Opposition continually drags up in this place in an attempt to con the electorate. The bill deserves Parliament's absolute support, because it is about delivering better clinical services, and I urge the House to support it.
Mr ANDREW CONSTANCE (Bega) [7.57 p.m.]: There is a stark contrast between the Government's highly concentrated and centralised bureaucratic approach to public health management in New South Wales and the community-engaged process heralded by the Opposition. While the Labor Party continues its ideological clandestine approach to public hospital management, communities continue to suffer badly. People are entitled to know that they can walk into a hospital and get treatment. People want health surety and health security. The health care policy legacy of the Carr Government is lost opportunity. Only two weeks ago the Premier waved the white flag and called for Canberra to take over public hospitals.
If the Labor Party has no ideas, no plans, no initiative to salvage this crisis, we do! Area health services are in debt, and we hear stories of neglect, poor service delivery, abuse of nurses, code red, code black, ambulances being redirected, hospitals without bandages and incontinence pads, mismanagement of nurse rosters, specialists being refused access to public hospitals—need I say more? That is the state of the health system in New South Wales in 2004. Tonight we are debating a bill that lacks any policy merit and will add to the systemic failures within health administration in New South Wales. Where is the policy leadership from the Labor Government on front-line service delivery? Where is the community engagement from bureaucracy that is needed to provide greater security and surety to local communities?
The bill amends the Health Services Act and the Public Sector Management Act to amalgamate 17 area health services into eight from 1 January 2005. Earlier this year I set about exposing the systemic failures of the Labor Party's Southern Area Health Service: its management and its financial inadequacies. The management and board structure of that area health service, which was $7 million in the red, were comprised of Labor Party hacks, with nepotism running rife in the culture of that organisation. At that time the Southern Area Health Service was a complete mess. A memorandum from Robert Arthurson, Director of Clinical Services, states that one hospital in the region ran out of basic clinical stock. He went on to state:
... there is the potential for clinical disasters or calamities if essential stock is suddenly found to be unavailable just when it is needed.
Area health service executives issued a memorandum in which they asked staff to take unpaid leave during December and January. Such a request by management was absolutely ludicrous, given that December-January is the busiest time for emergency departments, particularly on the South Coast. The reason for the action taken by those executives was to save on wage costs. The health service union met and backed my calls for an administrator to be appointed to the Southern Area Health Service. In its letter to members the union stated that members had no confidence in the ability of Southern Area Health Service executives to implement the management changes necessary to get the organisation back on its feet.
The Government then appointed Professor Stuart Schneider as administrator and only recently it announced his appointment as Chief Executive Officer of the merged Greater Murray and Southern Area Health Service. Ten months later nothing has changed in our public hospitals or in our health system. In the weeks to come I am sure that more will come to light. However, I inform the House that nurses continue to be bullied, patients are being turned away from local hospitals, ambulances are being diverted, and basic clinical stocks are not available in public hospitals on the coast. The Health Services Amendment Bill will do nothing to address that crisis.
The bill abolishes area health service boards, establishes area health advisory councils and establishes instead a health executive service. But that will be of no benefit to health professionals and to local communities who have been the victims of the Labor Government's incompetent management of health administration in New South Wales. The Coalition opposes the Government's amendments and instead seeks to institute a policy decision to reinstate hospital boards. The plan is to direct the health care decision-making process back to the community. This is all about giving people in the community control and a say.
The public are frustrated with the way in which the State Government has managed the health system. They deserve some input in the way in which their hospitals are run, instead of having to put up with decisions made by bureaucrats behind closed doors hundreds of kilometres away. Front-line service delivery should be the major focus of the health system. This legislation does not achieve that in any way. It puts the interests of bureaucrats ahead of the interests of patients. It directs the health system focus onto bureaucratic structures and not patient services and health outcomes. The Government has been trying to sell the idea that these measures will result in savings of $100 million, which will be ploughed back into front-line hospital services.
Clinicians and local communities, unlike the honourable member for Monaro, are best placed to determine what services are needed in their regions. That has never been more apparent in regional and rural areas, where service accessibility and availability are already compromised. There are real concerns about Labor's amalgamation policy relating to the Greater Murray and Southern Area Health services. The size of the new area, the diminution of local input in decision making, greater centralisation and worsening local services are issues of concern. The Southern Area Health Service, which covers one-third of the area of New South Wales, is expected to service 47 hospitals and health care facilities throughout the region.
As a result of the proposed amalgamation, coastal and other local communities will be more disfranchised. From a work force perspective, the access of workers to decision makers in the Southern Area Health Service will be further limited. Access to payroll officers, human resources and other clinical services will be further away, both logistically and geographically. From the time of this announcement my office has been inundated with calls from constituents and health professionals who have expressed frustration, apprehension and anger about the Government's decision to amalgamate services.
Terms such as "amalgamation" and "centralisation" in regional and rural New South Wales cause alarm bells to ring. Health advisory councils, which will comprise ministerially appointed clinicians and community-based consumer representatives, are intended to have an advisory, consultative, and liaison role in the operation of the area health service. How does that differ from the area health service boards that we previously had? There will be 13 members on the Southern Area Health Service Advisory Council, which covers one-third of New South Wales and will be responsible for 47 hospitals and health facilities. It just will not work. The Government is paying lip-service to the community if it pretends that there will be community consultation and input in the decision-making process.
Coalition members believe in hospital boards. We believe that hospital boards should work in conjunction with local bureaucracies to ensure that clinical service plans are mapped out, if need be, in regional areas. This is about ensuring that communities have a say in their local hospitals. The honourable member for Monaro is against this proposal. He is against the views of people in his community. They have no say in the decisions that will affect the future direction of their local hospitals, which I find incredibly disappointing. Only recently I attended a rally in Batemans Bay that was attended by more than 450 people. They all voted unanimously for the reinstatement of hospital boards. We want to ensure that this system works. Clinical service plans must not take away anything from competing interests in the regions.
People must have someone to whom they can go, someone who will make decisions about their local communities. There is nothing like a hospital board member at the local shops on a Sunday morning being kicked in the shins by someone who is unhappy about a failing in the hospital system. The Government believes in a highly bureaucratic and centralised approach. People on the ground want to be able to access bureaucracy, they want to be able to register complaints, and they want to be able to raise matters of importance. They are completely disfranchised. Too often they are being turned away by bureaucrats who do not know or understand hospitals in their local area.
In the past 18 months I have heard many stories—sometimes shocking—about the treatment of patients and the intimidation of health professionals in the Southern Area Health Service. I am concerned about what will happen when this health service expands. The Batemans Bay community was put through the wringer this year, with the closure of the maternity unit, extensive delays in the construction of the emergency department, and the threat of bed closures. No wonder that community is up in arms. It is sceptical about the Government's proposals. Earlier this year the Southern Area Health Service reduced the number of nurses on the roster at Batemans Bay hospital during the evening shift. As a result, and through no fault of their own, staff have been run off their feet and patients are not being seen to as quickly as they and their families would like them to be.
Because of recent occurrences I asked myself how this new structure would resolve those problems. It is a pity that the honourable member for Monaro is not in the Chamber, as I am sure he would not like what I am about to say. Last week a constituent from Eden—a constituent of the honourable member for Monaro—contacted my office. That same week the honourable member for Monaro appeared on the ABC in Bega and spoke about Bega hospital. Staff in the honourable member's office turned away that constituent as it concerned a matter to do with Bega hospital. The constituent wanted help to secure the services of a haematologist in Bega.
How can we retain services such as this when the Southern Area Health Service has to manage 47 hospitals that are experiencing the same problems? I have been in discussions with the haematologist and I secured an agreement with him. He is willing to charter a flight from Canberra to Merimbula to service 30 patients in the Bega Valley. Some patients in that area are critically ill and frail and some of them are undergoing chemotherapy. There is nothing worse than having to travel from Bega to Canberra in a car every fortnight simply because this Government cannot secure the services of a haematologist in the Bega Valley. The doctor is willing to continue the service. The challenge is for the Government and the health service to charter the flight for $1,500 instead of having to reimburse patients under the Isolated Patients Travel and Assistance Scheme. That would be a sensible outcome, but it would be a locally driven outcome. That is the point of the boards. If they were in place these types of situations could be easily resolved. Instead, the Department of Health and the Minister sat around for months waiting until the eleventh hour before a solution was found.
I am also disappointed that the doctor providing orthopaedic services at Bega District Hospital is leaving in a month. What is being done to resolve that issue? The emergency department at Bateman's Bay District Hospital was not built on time or in line with the Government's commitment. These problems are in the back of my mind. How will they be resolved by this new structure? The area that the advisory councils are required to oversee is far too big. I also have grave concerns about how the local health councils will operate in the new system, how they will report to the advisory council and what their relationship will be with the chief executive officer.
We have not had a response from the honourable member for Monaro about the issues raised by the honourable member for Wagga Wagga. It concerns me that the honourable member for Monaro has been quoted as saying that he lobbied the Minister hard to ensure that Queanbeyan would be the site of the headquarters of the new area health service, which would ensure that the town retained State Government jobs and the obvious economic contribution that they would make to the area. That suggests political interference. The honourable member went to his local community and claimed that he achieved that outcome. It is particularly interesting to note that on 14 September during the estimates committee hearing the Hon. Robyn Parker asked a question of the Minister about political interference in relation to the establishment of the new health services and their headquarters, and the Minister denied it. Someone is lying. It is more likely than not that the honourable member for Monaro is lauding his achievements in the local community. Having a Queanbeyan bureaucracy serving the coast does not work, and the local community knows that. I call on the Government to reinstate local hospital boards.
Mr JOHN MILLS (Wallsend) [8.12 p.m.]: It was not my intention to speak in this debate until about and hour ago when I heard the Opposition spokesperson for health, the Deputy Leader of the Opposition, refer to area health service boards. He said that they were loaded with Labor mates. Unfortunately, he named no-one. I felt sad that the honourable member would so belittle the enormous contribution made by many people in the community that I represent, namely, the Hunter. I have had a long association with health services in the Hunter, so I know that that attempt to belittle people was extraordinarily undeserved.
During the generation since area health service legislation was introduced in about 1986, and continued under the Greiner and Fahey governments, an enormous number of people, who until recently were generally unpaid, voluntarily took part in the governance of our health system. They did so to ensure that their local communities had input into the health services provided by the public sector in that region. Locals in the Hunter Valley identified strongly with that process. Unfortunately, what the Deputy Leader of the Opposition said belittled their contributions so much that I felt compelled to thank that generation of volunteers who took part in the governance of the health system across New South Wales. I know the volunteers of the Hunter best, of course, and there was one Labor mate in their ranks.
John Varnum, Deputy Commissioner of the New South Wales Industrial Relations Commission, formerly an organiser with the Transport Workers Union, was appointed as Chairman of the Hunter Health Board by none other than Peter Collins, the Liberal Minister for Health. Yet Deputy Leader of the Opposition has belittled Mr Varnum's enormous contribution to this State, and that is most unbecoming. I want to thank the many people who have for many years given their time to the health sector. Carol Abela is a former chairperson of Hunter Health. Dr Annette Carruthers, a general practitioner, was a member of boards over a number of years. Early in her career she took an active part in the Hunter Urban Division of General Practice and she has been a driving force behind the GP Access After Hours program, which is funded jointly by the New South Wales Government through Hunter Health and by the Federal Government. Annette has worked hard, hands on, not only as a doctor in the system but also in organising the system through the Hunter Urban Division of General Practice. These people are so far from being party hacks that it is not funny, but that was the belittling accusation made by the Deputy Leader of the Opposition.
The Hunter Health board members have included Brian Cogan, the managing director of a New South Wales based consultancy. Until recently, Professor Roger Holmes, the Vice-Chancellor of the University of Newcastle, also served on the board. Alison Howlett, a councillor on Singleton Council, and Michael Johns, a businessman, director of Newcastle Grammar School, member of the local show society committee and a prominent local identity have also served on the board. I encouraged Irina Lupish, a Russian woman, to apply for a position on the board because of her expertise in the non-English speaking background community and her position as a health worker at the Migrant Resource Centre in the Hunter. I have known Irina well for many years and I worked with her husband at BHP.
Barbara Oliver, a retired schoolteacher, Craig Ritchie, an Aboriginal chaplain and Ray Kelly, another Aboriginal person, have also been board members. For many years Ray was the Chief Executive Officer of the Awabakal Aboriginal Co-operative in Newcastle. Several people have also served as staff-elected representatives, including nurse Lyn Shepherd. Sister Margaret Sinclair, who signed the 2000-01 annual report with Carol Abela, the chairperson, represented the Sisters of Mercy, Singleton, and has been a wonderful contributor to Hunter Health. She is a close relative of the former Federal Leader of the National Party, but the Deputy Leader of the Opposition also belittled her contribution.
More recent members of the board have included Chairman David Evans, who was the manager of Hunter Water. He is now the manager of Sydney Water. John Fitzgerald is the former general manager of Goninans and a prominent businessman in Newcastle. Ken Moss, the managing director of Howard Smith Ltd and Chairman of Boral, was also a board member. Pauline Tregenza, a solicitor and barrister working in the Hunter, has also been a member. Others who have contributed to the Hunter Area Health Service include Phil Gardner, who has been the general manager of Western Suburbs Leagues Club for a few years and is also prominent in local business through Hunter Region Tourism; Violetta Walsh, the Director of the Migrant Resource Centre; and Henry Wilson from the Upper Hunter, who has been involved in so many public sector areas as a volunteer.
My thanks go to the people from the Hunter I have named, to those I have not named and to all the volunteers who for generations contributed so well to the governance of our public health system during the time that hospital boards existed. They did a great job, and it is much appreciated. Times move on, and we now have a new approach by way of the new legislation. But many people have made a great contribution to the Hunter Area Health Service over many years, and that contribution is much appreciated in the Hunter and in the wider community.
Mrs JUDY HOPWOOD (Hornsby) [8.20 p.m.]: The Health Services Amendment Bill amends the Health Services Act 1997 with respect to the control and management of area health services and statutory health corporations. I express a little concern about the word "control" in that description. The bill also amends the Public Sector Employment and Management Act 2002. In making these changes, the bill amalgamates the current 17 area health services into eight from January 2005. The bill also abolishes area health service boards and establishes area health advisory councils and a health executive service.
I join with my colleagues on this side of the House in expressing concern about the intent of the legislation. I believe it is a smokescreen and pipedream. It is yet to be explained exactly how the $100 million in savings is to be achieved. With regard to the allocation of the savings to hospitals, we are yet to hear what funding will be provided to Hornsby Hospital, which is now part of an area health service that has doubled in size, incorporating the Northern Sydney Area Health Service and the Central Coast Area Health Service. It is an extremely large area. The Northern Sydney Area Health Service chief executive officer, who previously had a heavy workload, will now manage a health service double the size of the Northern Sydney Area Health Service. I wish him good luck.
I am aware that the chief executive officer has been involved in meetings with clinicians who have expressed a great deal of concern about the lack of maintenance of Hornsby Hospital, the non-replacement of equipment, and extensive delays in the construction of the new accident and emergency department, the maternity unit and the paediatric unit, which is obviously a money-saving exercise. The clinicians have also expressed concern about the Hornsby Hospital waiting list. In response the chief executive officer has said that that is not a problem because the people are going to the Sydney Adventist Hospital. Given that the Sydney Adventist Hospital is a private hospital and Hornsby Hospital is a public hospital, I cannot understand how this could be so for everybody. There is a substantial cost to be a patient in the Sydney Adventist Hospital. I believe that is a furphy.
Hornsby Hospital services 250,000 people, although the chief executive officer tends to underestimate that number. That statement is of great concern. During other debates in this House I have said that the delivery of food services to Hornsby Hospital is at great risk because of the centralisation of the service in Gosford. The amalgamation of the two area health services is to be questioned. The Coalition wants to re-establish local hospital boards. The people of my electorate believe they do not have adequate input into what happens in the hospital, particularly in relation to the provision of services, maintenance work and upgrades. They are not happy about the current situation.
My office receives significant concerns about Hornsby Hospital's accident and emergency department, which is not allowed to go into code red but must sit on code amber despite the fact that it is full to the brim. A couple of extra beds in the hospital may be available, but the patients in the accident and emergency department are not able to use those beds. Therefore, the accident and emergency department staff continue to suffer the stress associated with continually receiving ambulance admissions. Recently I had occasion to visit Royal Prince Alfred Hospital, where a friend had given birth to a baby. I was informed that beds had been removed from some of the rooms in the maternity unit of that hospital because there was not enough staff to service them. As I was walking out of the hospital I noticed a sign next to the linen trolley that read, "Shortage of linen this weekend. Be careful of the linen". That is the story of life in our hospitals, and it is extremely distressing.
The honourable member for Auburn referred to an allegation made years ago about Lidcombe Hospital. She expressed concern about what the then Coalition Government had allegedly been responsible for. However, the present Government is doing exactly the same with regard to allowing hospitals to run down. I do not believe that Hornsby Hospital will receive any substantial funding out of the $100 million in savings that will allegedly be achieved. That is of great concern to the people the hospital serves. The Coalition opposes the bill. We will seek to institute Coalition policy in relation to hospital boards. The proof of the pudding will be in the eating so far as the objectives of the bill are concerned.
Mr GREG APLIN (Albury) [8.27 p.m.]: The Health Services Amendment Bill was introduced on 28 October. However, the Premier wrote to the Prime Minister on Wednesday 20 October proposing that the control of health services be handed to the Commonwealth. It is an interesting juxtaposition. On the following day the Prime Minister replied:
As you are aware, I am not persuaded at this stage that the effectiveness or efficiency of health care would be improved by the Government assuming responsibility for public hospitals.
The gains to be achieved … would be outweighed by the disadvantages for local hospitals and their communities of management by a distant and centralised health bureaucracy.
That is precisely what this bill is about. The amalgamated Greater Southern Area Health Service will be one-quarter the size of New South Wales, or the size of Victoria. That begs the question: Why not have only one area health service for New South Wales and centralise it in Sydney, Wagga Wagga, or perhaps Dubbo? That makes as much sense as having a single unit to service a quarter of the State centralised in Queanbeyan, which is in the shadow of Canberra. What does the Albury electorate think of the Government's plans to amend the Health Services Act? The Border Mail editorial of 11 September read:
Border residents appear to have every reason to be nervous about the new health structure being foisted on the region.
The new Greater Southern Area Health Service is a mega-administration already imposed on the people of Albury and every other centre it will be responsible for.
The strategy driving the new service has all the hallmarks of the failed One City bid.
It has, to all intents and purposes, been structured and imposed without consultation with those who matter most of all—the people who have an inalienable right to expect a health service that meets their needs efficiently and cost effectively.
Corowa Shire Council voiced similar concerns. The council also voiced its disgust at the reduction in local administration. An article in the Corowa Free Press of Wednesday 29 September read:
Corowa Shire Council is disgusted at the New South Wales Government's recent announcement to reduce the health regions from 17 to eight and consequential administration of Corowa from Queanbeyan.
Council will try to have the decision changed.
The creation of the super regions had been undertaken without any consultation with the Greater Murray Area Health Service. The formation of the Great Southern region has caused a great deal of concern due to the size and location of the administration centre at Queanbeyan. Further, the Murray Region Organisation of Councils considered the formation of the proposal to form the new health regions and objected to the proposal basically because the area is far too large and because there has been no consultation. The general manager stated:
The area is too large, it does not seem to take into account border issues which relate to the Murray area and to have the region administered from Queanbeyan which does not have any community interest with this area would seem most inappropriate.
AlburyCity wrote an open letter to the Minister for Health, which expressed its concern and disappointment at the proposal by the Minister to merge the Greater Murray Area Health Service and the Southern Area Health Service into the Greater Southern Area Health Service, to be based in Queanbeyan. The letter stated:
AlburyCity Council and its community believe that its health services declined when the Greater Murray Area Health Service was created and administered from Wagga Wagga. Doubling the size of the Health Service and further distancing its administration will only exacerbate this decline.
The ability to effectively manage an area health service relies heavily on accessible, available decision-making. We need a cohesive health service management structure, which incorporates the department, the clinicians and the community; not a large remote bureaucracy.
AlburyCity went on:
We understand the proposal of NSW Health to undertake this restructure is predicated in part on the recommendations of the Independent Pricing and Regulatory Tribunal [IPART] report into NSW Health - Focusing on Patient Care, which was published in August 2003.
It is worth noting that the tribunal did not recommend the amalgamation of area health services and goes to some length to recommend against boundary changes and area amalgamations.
AlburyCity Council concurs entirely with the tribunal's view that the proposed amalgamations will be disruptive and negate gains which we believe are already, and will continue to be made in our region.
Our specific concerns with this merger are:
• The new region is unlikely to be an autonomous decision-maker but rather subject to centralised, metropolitan-based decision making. This means that decisions that will impact on the effective and efficient delivery of health outcomes within the region are made without reference to rural, regional or even local issues.
AlburyCity Council can find no justification in the proposed merger of Greater Murray and Southern Area Health Service in terms of improved decision-making, consultation, accountability or service delivery. It simply makes no sense and is likely to undermine recent progress on forming an integrated Albury Wodonga Health Service.
Let us turn to that cross-border health agreement and what progress has been made to date. Last month I asked the Minister for Health about progress on the formation of this cross-border health agreement, to be known as Health Albury Wodonga. I received a response from the Minister in these terms:
I am advised by the Greater Area Health Service that the Cross-Border Health Agreement for health services in the Albury Wodonga region was signed on 25 July 2003. This agreement has enabled progression towards integrated management systems for elective and emergency services, which will improve access and efficiencies in terms of waiting lists. In addition, a joint Board Advisory Committee and a Joint Medical Consultative Committee have been established to progress joint medical appointments.
The Minister concluded:
All parties are committed to working together to progress this Agreement, which will continue under the Area Health Services' reform process.
But we need to expedite it. In the words of one of the senior specialists of the Albury Wodonga area, we need to make sure that the process is speeded up, by which Albury Base Hospital would become virtually a Victorian hospital. The alarm bells should ring loud and clear. On 14 October Dr Kevin Holwell was quoted as saying:
The board of Wodonga Regional Health Service and its chief executive, Dr Andrew Watson, were supposed to control the Albury hospital under the integration plan.
Dr Holwell said:
But Andrew has only nominal control and the Albury hospital is still run by Greater Murray Health Service because the States haven't changed the system.
A spokesman for the Minister said that border residents could look forward to integration being on track and fully implemented by July 2006. However, Dr Holwell said he saw progress as "frustratingly slow due to the differences in legislation in the two States", especially in regard to State awards. He said that 160 visiting medical officers were due to sign new contracts at Wodonga and Albury hospitals on January 31. Dr Holwell continued:
It would appear unreasonable to expect them to sign a contract with the Wodonga board to provide services at Albury Base when the Wodonga board and Dr Watson as manager do not have full control of the day-to-day affairs of the hospital.
I asked the Minister to commit to consult with the Victorian Minister for Health to ensure that the current three-year trial is given every chance of success. Unfortunately, the Minister failed to reply to that particular part of the question. Progress is being made, painfully slow as it is, and, of course, industrial relations are at the heart of it. When the Premier wrote to the Prime Minister indicating that health should perhaps be taken over by the Commonwealth he did not include industrial relations. And what is the major hurdle in achieving cross-border agreement? Nothing else but industrial relations issues. Let us look at what the Premier said in his letter to the Prime Minister. He said:
I think this should be done as quickly as possible, dealt with at a high level of principle, and not be allowed to bog down in detail and lengthy analysis.
I have news for the Premier. Only 10 days ago the nurses were extremely concerned at what skimming over the detail might mean for them. They wrote to me, and to many others, and said:
As nurses we are outraged at the possibility that nursing management may be excluded from the 2nd tier of the proposed new Area Health Service management structures.
As the majority of the health workforce at each facility it is absolutely vital that nursing is represented at the highest level of Area decision-making relating to nursing policy, practice, clinical activity and workforce.
Debate adjourned on motion, by leave, by Mr Greg Aplin.