Kiama District Hospital Closure

About this Item
SpeakersIsaksen The Hon Dorothy; Kirkby The Hon Elisabeth; Nile The Hon Elaine; Nile Reverend The Hon Fred; Macdonald The Hon Ian; Hannaford The Hon John
BusinessMatter of Public Importance

Matter of Public Interest

Motion by the Hon. Dorothy Isaksen agreed to:
      That the following important matter of public interest should be discussed forthwith:
          The closure of Kiama Public Hospital and the efforts of the community to maintain the hospital for the provision of health services.

The Hon. DOROTHY ISAKSEN [10.40]: I thank the Minister for allowing me to proceed with this matter forthwith. By courtesy of the Save Kiama Hospital committee's submission to the Illawarra Area Health Board dated 22nd November, 1990, I will give a short history of the Kiama District Hospital. Kiama Cottage Hospital was opened on 21st May, 1889, supported by many large donations and a subscription system. In January 1911 Kiama Cottage Hospital opened its first operating theatre, dispensing with the need to utilise ordinary rooms and rudimentary equipment, such as a kitchen table. A few years later a private ward was opened for patients who could afford additional fees. However, despite these additions it was only a matter of time before a new purpose-built facility would be required.

On 5th July, 1930, the district hospital was moved to a purpose-built facility in Bonaira Street, and by this time, whether by choice or otherwise, the new hospital was accepting treatment for all streams of medicine. The community nature of the hospital remained, this being highlighted by the continuation of donations of goods and services, such as food and labour. On 24th November, 1951, a major addition to the new hospital took place. The addition was called Birrahlee, which is Aboriginal for babies. I draw the attention of the House to the fact that the fist baby born in Birrahlee was the well-known international footballer, Mick Cronin. Birrahlee was a 10-bed maternity wing, which increased to an 18-bed wing in 1963. From that time to the mid-1980s there was an expected growth in services offered by Kiama District Hospital to cater for increasing surgery in the 1960s, with the completion of a new operating theatre in 1974, involvement in Meals-on-Wheels from 1970, the appointment of a full-time physiotherapist in 1974, and the establishment of both a day care centre and rehabilitation unit in 1984.

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Despite these expansions in services, in 1988 under this Government we saw the closure of Birrahlee obstetric unit, the operating theatre and approximately 39 beds, reducing the 63-bed capacity to 24 operational beds. Before these changes were introduced, Kiama District Hospital treated an average of 35 patients a day,and handled more than 850 operations and an average 225 births annually. It is sad that this fine community hospital, which has been the focus of health delivery in the Kiama district since May 1889 - 102 years - has been closed, despite a firm commitment from this Government that it would be protected. The Premier gave this commitment when he was Leader of the Opposition, and the former Minister for Health, Peter Collins, gave a commitment prior to the May 1991 elections, in press release No.91/123 dated 15th May, 1991 - almost 12 months ago. The last sentence of the press release reads, "The hospital will not close after the State election, Mr Collins said". I draw attention also to the strategic priority statement of the Illawarra Area Health Service dated January 1989, titled "Looking Ahead 1989-93", under the signature of the Chairman of the Illawarra Area Health Service Board, Mr J. McKenna. That statement reads:
      This strategic priority statement outlines the general directions and priorities that the Illawarra Area Health Service will take over the next five years. It has been prepared against a background of major organisational change and increasing financial constraint. The strategic priority statement has been prepared to allow both health care providers and the community to gain an appreciation of planned growth and development of health services in the Illawarra. Such an appreciation is essential if we are to work together for a healthier community.

The statement continues:
      The population of the Illawarra is relatively youthful with the area having a larger percentage of children and a smaller percentage of aged people than New South Wales as a whole. However, there is a marked variation throughout the area, with the Shoalhaven and Kiama having a large and growing proportion of over 65s. In addition, the number of older people is expected to increase faster in the Illawarra than in New South Wales as a whole. The ageing of the population will result in an increased need for health services. Public transport in the Illawarra is poor, resulting in a high dependence on private cars. For residents without private cars, transport is a major factor in the lack of accessibility to health care.

Page 6 of the statement reads:
      In 1987, 85 percent of health care for Illawarra residents was provided in the area. By 1991, it is the board's objective that 95 percent of the health care will be provided locally in either the private or public sector. In order to achieve this goal, the area health service will . . . upgrade and renovate the Kiama District Hospital, to allow it to develop a specialist role in rehabilitation.

Page 10 of the statement, under the heading "Kiama District Hospital", reads:
      The Kiama District Hospital will continue to perform a local role for Kiama and surrounding towns, with general practitioners being the key providers of medical services. The hospital will provide primary and emergency care and medical services and will continue to act as an observation facility for children. Seriously sick children will be transferred to Wollongong. In recognition of the needs of the local community, the Kiama District Hospital will develop a new role in providing rehabilitation service linked with services provided at Port Kembla hospital. In addition, the Kiama area will be incorporated into a network of palliative care services to provide for the needs of the terminally ill.

The plans of the Illawarra Area Health Service were to span the years 1989 to 1993. Some months after the release of the priority statement a well-attended public meeting was held in Kiama to consider the views of the community on the future of Kiama District Hospital. The chairman of the Illawarra Area Health Service Board, Mr McKenna, attended the meeting. A committee was set up under the title of "Save Kiama Hospital" to investigate ways of retaining and improving the hospital services. The Save Kiama Hospital committee has four major objectives: to have hospital services
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in Kiama reinstated and upgraded; to seek some form of direct community input or community control of hospital services in Kiama; to provide for community access to the hospital via the continuing provision of public beds; and to ensure that the jobs of existing staff at the hospital are protected.

Over a period representatives from the Illawarra Area Health Services met with members of the community and decided to proceed with the proposal for the establishment of a community co-operative which would run the hospital and enable the Illawarra Area Health Service to fund 13 beds. The deadline for the commencement of that arrangement was 1st November, 1991. It was extended to 1st December and then to 1st February, 1992, but nothing has happened. Prior to Christmas the Minister commissioned the Reid Harris report, which was to be completed within a short period. It was established that nothing could really be resolved because a group of consultants was looking at the matter at that time. It was with extreme difficulty that the community eventually obtained a copy of the report, which states in part:
      The issues confronting the Illawarra Area Health Service are complex. The extent to which some of these are addressed in this review has necessarily been limited. In fact the capacity to undertake the review within the time frame was largely attributable to the excellent information base maintained by the Area Health Service and the strategic and corporate planning which had already occurred.

The report established that the decision had already been made by the area health service, and the people it was representing. The whole process was a farce. The report justified the area health service closing Kiama hospital to balance the budget, which at the time was something like $4 million overdrawn. The outcome was that the Chairman and the Deputy Chairman of the Illawarra Area Health Service decided to resign as a result of the decision to close Kiama hospital. I am now informed that the Chief Executive Officer of the Illawarra Area Health Service, Mr John Rasa, has this week tendered his resignation. All the pawns in the game have had enough. Their loss of face in their community has taken its toll. Where does this leave the people of Kiama? Their local member, Bob Harrison, has on a number of occasions tried to arrange a deputation to the Minister for Health Services Management to discuss the future of the hospital. This has been denied him. At the same time, the Minister received a somewhat secret deputation which included the Mayor of Kiama to discuss the hospital. To deny Mr Harrison, the elected representative of the people, the right to speak to the Minister on behalf of his community is a very petty, silly and childish performance from a Minister of the Crown. After all, Kiama is regarded as a safe Labor seat. Perhaps that is the problem.

The Government has chosen to make a political decision about the allocation of health resources in the Illawarra region. The former Chairman and Deputy Chairman of the Illawarra Area Health Service were Government supporters but even they had had enough. The people of Kiama want to know what are the Government's plans for their now empty hospital. I understand it is a very valuable piece of real estate. Is it the Government's intention to sell the land? I understand that the Illawarra Area Health Service has title to the property. This property was purchased by the people of Kiama, and the Government has no right to dispose of it to balance its budget. I ask the Minister to assure the Kiama community that the hospital will not be sold either for real estate or to a private hospital operator. If the Government is determined that the hospital is surplus to its health needs I ask the Minister that the deeds of the hospital be returned to the council so that the property can be returned to the community.

The Hon. ELISABETH KIRKBY [10.54]: After the Hon. Dorothy Isaksen gave notice yesterday to bring on this debate today I wanted to prepare myself, so I obtained
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a number of press clippings about the problem with the hospital at Kiama from the Parliamentary Library. It seems to me that, for whatever reason, the people living in the Kiama area have suffered as a result of confusing messages from members on the hospital board, from their own local council and from the Illawarra Area Health Service as well as from the Minister for Health Services Management. I say that because in the space of just over two months the whole situation has escalated because of these confusing messages. For example, the Illawarra Mercury of 13th March, carried the headline "Hospital board chiefs quit. Government steps in." On that date the Minister for Health Services Management, Ron Phillips, intervened to prevent the closure of Kiama hospital in-patient services after the shock resignations of the Illawarra Area Health Service Chairman, John McKenna, and Vice Chairman, John Hinton. They resigned after the board had voted to remove patients and permanent staff to Shellharbour hospital until the Department of Health decided whether to convert Kiama hospital to a community co-operative.

At that time a ministerial spokesperson said that Mr Phillips would refuse any reduction in services until a final decision on the hospital's future was made; the Minister would allow services in Kiama to be maintained in their present form until the future of Kiama health services had been resolved. That was only on 13th March. Some days later the Illawarra Mercury reported that the Community Hospital Co-operative's proposal to contract 13 public beds would give the community 4,745 bed days, compared with only 2,620 beds that would be offered at the Shellharbour hospital. Dr Grant, who was leading this move for the Kiama Community Hospital Co-operative, said that Kiama was growing as fast as the Shoalhaven, and that any excess beds at Shellharbour would soon be taken up by the growing population. It was then pointed out to the community that the Illawarra Area Health Service had offered only eight beds at the Shellharbour hospital for residents from Kiama and therefore of course the committee, which by that time had been fielding all the public protests, demanded the re-opening of Kiama hospital.

This further confused residents in the community, who really believed at that time that Kiama hospital, which originally had been set up by the community on land donated by charitable benefactors in the community, did not belong to the Department of Health, that it did not belong to the Illawarra Area Health Service, that the land and the building belonged to the community and therefore the Minister had no control over it. This was widely circulated. The local council decided to search for the title deeds, called for legal advice and tried to prove that it had a right to that hospital; that as it belonged to the community, it should remain under community control. The search and the legal investigations took some time. During that time the escalation had continued and by Wednesday, lst April the Minister, who only two weeks previously had been saying he wished the Kiama hospital to remain open, had made a statement that his word was now final, the hospital would close. He told the Kiama Independent that further deputations and protests by the community to have the hospital reopened would be a waste of time. In the space of only two weeks the Minister had totally and absolutely changed his position. I cannot understand why, because certainly within that two-week period he had been receiving more information. Indeed, he must have been flooded with information. Some of it came from leading doctors in the area, who pointed out to him the demographic fact that Kiama's population is expected to grow from 15,000 to 24,000 in the next 15 years and that there will then be 250,000 people living south of Dapto.

What does the Minister say in response to this situation? He says, "It is quite
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okay. It will take only 20 minutes for patients from Kiama to be taken to the Shoalhaven Hospital in Shoalhaven Street, Nowra". The distance between Kiama and Nowra is 61 kilometres. I have begun to believe that there are members, both of the Cabinet and the bureaucracy, who have no idea of the distances in country New South Wales; they certainly have no idea of the condition of the roads. If the Minister expects a private car or an ambulance to travel from Kiama to Nowra, 61 kilometres, in 20 minutes, he has rocks in his head - to put it crudely. A driver would certainly be hauled over the coals by police because he would be required to break the speed limit. An ambulance carrying a seriously sick patient could not travel at that speed without endangering the life of the patient. This is a totally specious argument, and it is quite wrong for the Government to try to persuade the community that everything is all right.

The result of the search was very disappointing. By Wednesday, 22nd April, it was discovered that quite legally in 1986 the Kiama District Hospital was transferred to the Illawarra Area Health Service and the body corporate of the Kiama District Hospital was dissolved on that date. Therefore, there is no legal recourse for the people of the Kiama area. In the Port Stephens area yesterday a one-man ambulance carrying a very sick patient had to be driven by that patient's son so that the one ambulance officer could sit in the back of the ambulance and attempt to revive this seriously ill elderly woman, who later died. Just as it cannot be suggested that a one-man ambulance can provide suitable health services, it cannot be suggested that suitable health services would be provided to the people of Kiama by having the nearest hospital service casualties and serious emergencies when the nearest hospital is 61 kilometres away. That is why it gives me great pleasure to support the matter of public interest proposed by the Hon. Dorothy Isaksen.

In conclusion, I hope that next week at the Special Premiers Conference the colleagues of the Hon. Dorothy Isaksen will bring some pressure to bear on the Federal Minister for Health, Brian Howe, and insist that funds from the Medicare levy be paid to New South Wales on the basis of the size of our population. The Medicare levy cannot be regarded as ordinary income tax. It cannot be shared out among the States at the whim of the Federal Government. New South Wales has the largest population. Therefore, it must receive the largest share of funds from the Medicare levy. It has to be taken into account that not only is New South Wales the largest State in population but also it has large numbers of people living in country towns. Although, from an accountant's point of view, it may not be economic to keep some of the smaller country hospitals open, it is essential that they be kept open if there are not to be further tragedies such as the one that occurred in the Port Stephens area yesterday.

The Hon. ELAINE NILE [11.3]: I support the matter of public interest that seeks an inquiry into the reopening of Kiama District Hospital. I am a resident of the South Coast area. I have been backwards and forwards from that area since 1953. I am very concerned about the closing of Kiama hospital, especially as last February a member of our family was involved in an accident in that area. We were told to go to Shellharbour Hospital, not realising that Kiama hospital was open. There is a lack of awareness in the area about what is happening with that hospital. Politics has marred the debate on Kiama hospital since the late 1980s, but the final blow to the century-old hospital has been blamed on the politics of the 1990s. Kiama Town Clerk, Brian Petschler, predicted in February this year that political influences may decide the final fate of the community hospital. The honourable member for South Coast has been outspoken on health cuts to his electorate and an inequitable share of the health dollar. Mr Hatton has put pressure on the New South Wales Government for a fair share of the State's funding to be allocated to meet the needs of Shoalhaven residents, which has had
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an impact on Macquarie Street, Sydney, and the Department of Health bureaucrats. Some sections of the Kiama community blame Mr Hatton for the final rejection of the plans of the Kiama Hospital Community Co-operative. However, the political battles over the hospital have hit the headlines since the late 1980s. Under the Wran and Unsworth Labor governments, Illawarra's health funding declined. Ironically, in 1987 the then Opposition health spokesman, Peter Collins, said:
      Labor's record in the whole of NSW tells of massive neglect and mismanagement.
      In the Illawarra region the story is the same.

In August 1987, Kiama mayor, Arthur Campbell, predicted that the proposed closure of the maternity ward would signal the start of a program to downgrade the hospital. The then Labor health Minister, Peter Anderson, overruled the decision of the Illawarra Area Health Service to close the maternity ward just six months before the March State election. However, despite the rhetoric and political posturing of the Liberal Opposition, the major cuts to the hospital, which received wide media coverage, occurred under the coalition Government after it ended 12 years of Labor in 1988. In December 1988 the hospital's maternity ward and operating theatre were closed. Nursing numbers dropped by almost half to 22, and only 20 general medical beds were in use at the hospital compared with 57 before the closure of the two wards. Several well-attended public meetings in the municipality stalled further cutbacks. A save the Kiama hospital committee was formed which received bipartisan support in the town. The committee produced a report that stated that it was feasible for the hospital to be run by the community, with there being a mixture of public and private beds. The report, which was amended several times, was rejected in the middle of March by the Department of Health and this week by the Illawarra Area Health Service. But the 10,000-plus community continues to fight for its hospital. Dr David Grant warned that tourists visiting Kiama would be endangered by the latest moves to close the hospital. He said that regular tourists would be unaware of cuts to hospital services and would still show up at Kiama hospital. Dr Grant said:
      We're coming straight up to Easter - the second busiest time of the year . . .
      They'll get here and there won't even be a hospital. They won't be able to go anywhere in the traffic.

Honourable members, and especially the Ministers with portfolios in the health area, if put in the same position as my husband and I when a member of our family was put at risk, would have a better understanding of the situation. Dr Grant said:
      It's something that's very hard to advertise to people in Sydney.

Dr Grant said that the Illawarra Area Health Service plans to open Shellharbour Hospital beds to accommodate Kiama residents, but this will result in a further service reduction for local residents. He said that the proposal of the Kiama Community Hospital Co-operative to contract 13 public beds would have given the community 4,745 bed-days compared with only 2,620 to be offered at Shellharbour. He said:
      We are growing as fast as the Shoalhaven. Any excess beds at Shellharbour will soon be taken up by the growing population here . . .
      Is there some kind of guarantee they're not going to close beds again?

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Dr Grant said that while Kiama doctors were being offered admitting rights at Shellharbour, some would be unable to offer equal care. He said:
      I don't feel I can look after my patients at Shellharbour the way I can at Kiama. I just can't be as available.

Mr Brian Petschler of Kiama council said that on 15th May, 1989, a record public meeting called to express concern at the steady loss of services at the Kiama District Hospital elected the Save Kiama Hospital committee. The committee was empowered to undertake negotiations with the Illawarra Area Health Service on the future of the hospital. Following investigations up to February 1990, the committee realised that the hospital would eventually be closed if it remained in the public system. It was put to the Government that it be transferred from the IAHS to a community-based organisation to be run as a community hospital. Consultants were engaged, funded by the Kiama Municipal Council, to present a case. The issue was taken to the Minister for Health Services Management by deputation. He advised that the committee would have to deal with the IAHS board of directors, which would make the final decision. A proposal was developed and eventually agreed to by the IAHS as follows: a community co-operative was to be established; the hospital would be leased to the co-operative on a 10-year lease, with a further 10-year option; the co-operative would engage professional management, input at least $1 million in capital works during the first 10 years and a further $1 million in the second 10 years; and ensure a high standard of care. The IAHS would approve a 30-bed hospital, with 13 beds to be available for public or uninsured patients. The IAHS would provide funding for the 13 public beds at a starting rate of $245 per day. That funding would be for two years and adjusted in accordance with the consumer price index. For example, if eight beds were used, it would pay for only those eight beds. This daily bed rate is at least $60 less than the lowest cost of any of the IAHS hospitals. It is more than $100 per day less than the cost at Shellharbour Public Hospital.

The Kiama Community Hospital Co-operative Limited has undertaken to raise the necessary capital prior to taking over the hospital and has a co-operative membership plan and a professional fund-raising plan in place and ready to go. It is planned to raise in excess of $500,000 in the first three months and for the initial fund-raising in the first year to exceed $1 million. Tax exempt status has been obtained from the Australian Taxation Office, and a professional management team has been selected. The legal documents with the IAHS had been drawn up. However, the Minister then advised that the New South Wales Department of Health would not issue the necessary licence approval and subsequently the hospital has been closed, despite the IAHS approval of the agreement. The people of Kiama feel as if they have been bypassed. Most members and constituents living in Kiama, Gerringong and Gerroa in the Illawarra electorate believe that if a member of the Legislative Assembly could only represent and speak on behalf of the Kiama hospital in the lower House, perhaps something would happen. We do ask the Minister to think very deeply about the whole issue.

Reverend the Hon. F. J. NILE [11.12]: I am pleased to support the matter of public importance dealing with the closure of the Kiama District Hospital and the efforts of the community to maintain the hospital for the provision of health services. The issue being discussed is a matter of urgency and concerns the reopening of Kiama hospital. I urge the Government to accept the offer made by the Kiama Community Hospital Co-operative, which is comprised of responsible leading citizens and doctors and has the full support of the Kiama council and its aldermen. I urge the Government to accept that offer to reopen the hospital. I know that the Government is deeply concerned about budget considerations because of the serious $1.5 billion deficit. But Kiama hospital
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should not be a victim of economic cost cutting in an endeavour to meet budget constraints. The Kiama Community Hospital Co-operative is offering to run the hospital. This morning I had discussions with the officers of the hospital, and they are prepared to negotiate a two-year trial with the Government. I am aware that the Government may have other advice that such a proposal is not viable.

The best way to test the viability of the offer made by the Kiama Community Hospital Co-operative is to give it a chance and give it an opportunity to reopen the hospital under the Minister's direction and authority, for example, to conduct from 11th July a two-year trial period until 30th June, 1994. In such a trial period the Government would have full opportunity to assess the efforts made by the co-operative, and the co-operative also will have a fair chance to make this big and expensive project, where costs are to be borne by the local community, financially viable. That is what it is prepared to do. I believe it is unique to our State that people in local communities are not merely lobbying the Government for more money but are really saying to the Government, "Give us a chance and we will show you that it works". Unfortunately, the handling of this whole issue, from a political point of view - and I think the Minister would agree - in many ways has been disastrous. The entire community in the Illawarra electorate and the Kiama residents in particular are very angry and disturbed about what has happened and how it has been handled by the Government and by the Illawarra Area Health Services Board, and with the litany of broken promises, backtracking and confusion. Promises were made that the hospital would not be closed down, yet services have been whittled down and removed. That whittling down process led to the people of Kiama suspecting instinctively that the Government would close down the hospital, but they were reassured that it would not be closed. Last weekend I visited the Kiama hospital. That hospital is not dilapidated but is efficiently run and has well laid out buildings in beautiful grounds on an excellent site surrounded by parklands and is blessed with ocean and mountain views. The hospital should not be closed down. People suffering health problems could not find themselves in a better environment for the restoration of their health, assisted by the medical profession, than at Kiama hospital.

During my visit at the weekend to the hospital and again this morning I had discussion with the hospital co-operative about the draft agreement that has been drawn up. A big sign at the front of the hospital has the word "closed" stuck over the name "Kiama District Hospital". That is a slap in the face for Kiama residents. The hospital is on a prime site that is passed by many residents and tourists on their way to the beach areas. In my discussions with representatives of the Kiama Community Hospital Co-operative I said that the Government must have some way of evaluating the viability of the project. Those representatives acknowledged that, and in fact their agreement has been drawn up incorporating all those checks and balances and procedures necessary for monitoring the Kiama hospital under the co-operative. The co-operative does not want to receive a blank cheque from the Government but later to be forced to say, "It has not worked and we need the Government to bail us out". That will not happen due to the built-in process of evaluation of the economics of the project and provision of services. The Government, through the Illawarra Area Health Services Board, would have hands-on monitoring and would not be taken by surprise.

I have just been handed a copy of a letter from Mr Petschler, Secretary of the Kiama Community Hospital Co-operative Limited. This letter has only just been sent to the Minister for Health Services Management. I understand that a similar letter has been sent to the Minister for Health and Community Services, though he may not yet have seen it. Debate has reached a point at which this matter may be easy to resolve. Though such resolution in detail may not be possible on the floor of the House today, the
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Government would be taking a tremendous step forward in its relations with the people of Kiama and would enhance good will if it indicated willingness to reopen this matter, to meet with officials of the co-operative, to examine the proposed agreement in detail, and to put any further questions, however hard those questions may be, for the co-operative to come up with answers. The hospital could be reopened by 1st July this year. The co-operative says that it is ready to go; everything is in place. Today I asked whether it was possible to reopen the hospital if the Government said yes. The co-operative said: "Yes. The doctors are available and the staff are available". The letter from the Kiama Community Hospital Co-operative Limited reads:
      Dear Mr Phillips
Future of Kiama Hospital
      The Co-operative is in receipt of a letter from Mr. Amos the Director General of the NSW Health Department, to Mr. R. J. Harrison, M.P., Member for Kiama, which provides the basis on which the Co-operative proposal for Kiama Hospital was not approved at this time.
      The Co-operative believes that the decision should be reviewed. The "forward commitment of public funds" to which Mr. Amos referred was, in fact, the payment for bed use by uninsured patients at a rate significantly lower than can be achieved at any of the other public hospitals in the region. There may be some short term financial gain from re-opening the currently unused beds at Shellharbour Hospital, but after the initial budget benefits (applicable to this year only) the annual costs of those beds will far exceed the cost of the Kiama proposal.
      The Director General also expressed concern at the Co-operative's "financial viability". The Kiama community has clearly shown its strong support for the proposal, and a plea is now made to you for the Co-operative to be given the opportunity to show it can succeed by granting it a 2 year trial period, commencing on 1st July, 1992, for that viability to be tested.
      The lease agreement and the bed licence agreement which has been drawn up provide an opportunity for the IAHS to monitor both the Co-operative's operations during this period as well as the high standard of care which it will provide. The continuation of the proposal can be reviewed at the end of the trial period.
      The Co-operative is aware of the pressure on both Shellharbour and Shoalhaven Public Hospitals for acute care beds and to the Chief Executive Officer's advice that these must remain as a IAHS high priority. The Kiama Co-operative proposal provides some cost effective, slow stream medical beds for the region's use which will enable the IAHS to focus more effectively on that high care requirement in the major hospitals.
      Your urgent reconsideration of the Co-operative proposal is now respectfully requested.
Yours faithfully,
B. Petschler,

I know that the Government is involved with controversy in Port Macquarie about privatisation but let us work with the community in Kiama. [Time expired.]

The Hon. I. M. MACDONALD [11.22]: I support the matter of public interest raised by the Hon. Dorothy Isaksen. I congratulate her and Reverend the Hon. F. J. Nile on his positive contribution on Kiama hospital this morning. It is an excellent idea that the project proceed under the auspices of the Kiama Community Hospital Co-operative Limited. That would be achievable. Reverend the Hon. F. J. Nile has pointed out that doctors and staff are available in the area and there is a great need for such a hospital in Kiama. The Illawarra Area Health Service, in its priorities statement of January 1989, made it clear that there was a major role for Kiama District Hospital. At page 10 the
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report states:
      The Kiama District Hospital will continue to perform a local role for Kiama and surrounding towns with general practitioners being the key providers of medical services.
      The hospital will provide primary and emergency care and medical services and will continue to act as an observation facility for children. Seriously sick children will be transferred to Wollongong. In recognition of the needs of the local community, the Kiama District Hospital will develop a new role in providing rehabilitation services linked with services provided by Port Kembla Hospital. In addition, the Kiama area will be incorporated into a network of palliative care services to provide for the needs of the terminally ill.

The Kiama District Hospital played a most necessary role in the area. It is some distance from Kiama to alternative health care. The Kiama area is growing enormously. Recently when I attended meetings of the State Development Committee in Kiama I noted how much the small village of 12 years ago had grown into a large dormitory suburb to the whole of the Illawarra region, and particularly for the work force of Wollongong. As a consequence it has great medical and health needs. The Illawarra Area Health Service made it clear in its priorities statement that there is a strategic need for the hospital to remain open to service the community. When the Premier was Leader of the Opposition he made many strong statements about the need to retain Kiama hospital. For instance, in the Kiama Independent of 18th June, 1986, an article stated that the then Leader of the Opposition, Mr Greiner, was very keen to ensure that the Kiama hospital remained open. He said that he regarded the previous treatment as being the "death of a thousand cuts". He went on to make it clear that such a hospital had a major role to play in the health services of the Illawarra area. He said that Mr Unsworth, the Premier at the time, should have ensured the survival of the hospital's existing services after the introduction of the area health boards in October. He said that the speculation at the time was part of the long running saga of doubt over the hospital's future, each episode only decreasing community confidence in the hospital's survival. It upset the staff, the patients and the public. He went on to say that Kiama also deserved an autonomous hospital administration which would decide the best way of meeting the health care needs of the community. He said:
      The ALP promised during the Kiama by-election this year that the hospital will remain - that promise must be kept if the ALP hopes to maintain any integrity at all.

How ironic. Those words are coming from the present Premier. In 1986 he was saying that the ALP must keep its promise to keep the hospital open. He pointed out the need for the hospital. Yet this Government has closed the hospital and so far has made no clear statement that the hospital could be reopened in future under the proposals of the co-operative supported here so ably today by Reverend the Hon. F. J. Nile. The previous Minister for Health, Peter Collins, issued the following statement on the subject:
      Alderman Harrison's claims about the future of Kiama Hospital are totally without foundation. The Hospital will not close after the State election.

This statement was made on 15th May, 1991, just four days prior to the election. The Premier and his possible successor in the near future, Peter Collins, both directly stated that the hospital would not close after the election. The press release by Mr Collins was headed "ALP running scared in Kiama". The press release also stated that the ALP candidate for the seat of Kiama had:
      . . . resorted to "bottom of the barrel" tactics with claims about the future of Kiama Hospital.
      Mr Collins said that the ALP is showing signs of desperation by trying to create fear in
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the Kiama community.
      "The Labor Party candidate has taken up the theme of lies and deception currently being run by the Shadow Minister for Health.
      "The ALP knows that time is running out, and has embarked on a campaign designed to spread fear by making misleading statements about the future of health services.

He went on to say that the hospital would not close after the State election. Mr President, I ask you and all honourable members: who is acting with integrity in relation to this matter? Those sorts of statements by two senior members of the Government - the Premier and the potential future Premier - about Kiama hospital have been shown to be abject lies. The hospital has been closed and the Government is not seriously endeavouring to reopen it. The co-operative proposal outlined by Reverend the Hon. F. J. Nile is reasonable and shows community initiative. It shows a desire by the community to become involved in the running of the hospital. The proposal has a chance to succeed if it is given proper and adequate support. I reiterate that, as Opposition members have stated on many occasions in this Chamber, the history of the Greiner Government will be recorded as a litany of broken promises, of promises idly made to the people of New South Wales prior to elections and promises quickly broken without the integrity of the Government being questioned. The media statement by the Hon. Peter Collins, the then Minister for Health, fits into a long line of promises which have been broken after an election has been disposed of. I support the attempts by Reverend the Hon. F. J. Nile and the Hon. Dorothy Isaksen to try to get the Government to exercise some common sense in relation to health policy, to stop playing politics and to allow a community hospital to reopen. Documentation about the health needs of the area shows that such a hospital has served and can continue to serve a demonstrated need in the community of Kiama.

The Hon. J. P. HANNAFORD (Minister for Health and Community Services) [11.31]: I was interested to note the comment of the Hon. I. M. Macdonald that the proposal put forward by the Kiama Community Hospital Co-operative Limited was a most excellent proposal.

The Hon. I. M. Macdonald: No. I referred to the proposal put forward by Reverend the Hon. F. J. Nile.

The Hon. J. P. HANNAFORD: The Hon. I. M. Macdonald said that he completely supported the proposal by the Kiama co-operative for a two-year trial for the hospital to be run by the co-operative. If I heard the Hon. Dorothy Isaksen correctly, she also called for such a proposal and lent her support to the co-operative taking control of the hospital. Two Labor members in this House support the proposal. I want to place it clearly on the record that that is the approach taken by the two speakers from the Australian Labor Party on this proposal. No member of this House has any doubt that they have said in this House and to the people of Kiama that the Kiama Community Hospital Co-operative Limited should be given control of the hospital for a two-year period. I welcome the new approach of the Australian Labor Party to the delivery of health services in New South Wales. I want to place it clearly on the record that the Labor Party has now changed its policy towards the provision of health services in New South Wales and has welcomed a private investment proposal for the delivery of health services in New South Wales that is exactly in line with the Port Macquarie hospital joint venture proposal.

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The approach taken by the Labor Party in this House is a total rejection of the approach taken by the Leader of the Opposition and the shadow minister for health in the lower House towards the Port Macquarie joint venture proposal. I make it clear that the Labor Party in this House is adopting the Port Macquarie joint venture concept in relation to Kiama hospital. The Hon. I. M. Macdonald is shaking his head; the record will clearly show what he said in this House. He must stand for one proposal or another. He either supports the co-operative proposal, which is what he spoke in favour of in this House, or he does not. His words on this issue will hang him. They will be taken by me to Port Macquarie, to the Public Accounts Committee, and to Kiama. The Government will clearly remind the people of New South Wales of his words during the next few weeks.

The Hon. I. M. Macdonald: The Minister would be verballing me.

The Hon. J. P. HANNAFORD: The Hon. I. M. Macdonald has rejected completely the approach of his health spokesman to joint venture investments in public hospitals. I should like to summarise the present circumstances in Kiama and the important events leading to the decision in relation to Kiama hospital. The admission of inpatients to Kiama hospital ceased in mid-March 1992, about two months ago. From that time patients and staff have been transferred to nearby Shellharbour hospital, a new state-of-the-art hospital less than 10 kilometres from Kiama. It is interesting to note that the Hon. Elisabeth Kirkby made no reference to Shellharbour hospital in her contribution but referred to proposals in relation to Nowra. The journey from Kiama to Shellharbour takes about 15 minutes - 20 minutes at the most. The doctors' admitting rights were also transferred at that time. The area health service proposed that a community consultative process be established to explore further options for health services in Kiama. I am advised that local community groups and Kiama council have been approached to participate in that process. Other health services have continued to be provided by Kiama hospital to the local community. The day service unit, which is in the hospital's grounds, continues to offer dental services, speech pathology, social work, physiotherapy, diversional therapy and podiatry services. Kiama residents also have access to a broad range of community health services which are available from the community health centre located in the Kiama central business district.

In answer to questions asked about what is proposed for the hospital site, I inform the House that the site will be retained for health purposes and those community health services to which I have referred will continue to be provided from the site. The site will continue to be available for that purpose; the department has no other purpose for it. The suggestion by the Labor Party - for its own political purposes - that the site will be sold is totally without foundation. Kiama hospital was downgraded by the Labor Party to 13 beds. That downgrading could only be described as leaving the hospital as a low-grade facility. The hospital was not providing, nor had it been providing for some time, genuine acute hospital services. Accident and emergency services were not provided. Ambulance emergency cases had been bypassing Kiama hospital since the opening of Shellharbour hospital in 1985. That is, for seven years ambulances had not been going to the hospital. Treatment room facilities were available for those local residents who did not have a general practitioner. However, the treatment room was staffed only by nurses with doctors attending only when they were called. So doctors' services were not automatically provided at the treatment room. The majority of accident cases were treated by general practitioners in their rooms. Inpatient services which were provided included slowstream medicine and rehabilitation, and accommodation of patients
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awaiting nursing home placement.

I should like to place some important figures on the record. In 1990-91 only 9 per cent of Kiama residents who were admitted to public hospitals generally were admitted to Kiama hospital. Ninety-one per cent of Kiama residents who needed to go to hospital were admitted to hospitals outside Kiama. Seventy-five per cent of Kiama residents who needed hospital treatment were admitted to other hospitals in the Illawarra area. The majority of them, 22 per cent, went to Shellharbour hospital; 28 per cent to the local private hospital; and 19 per cent to the Illawarra regional hospital. Obviously the hospital was not providing the services required by the majority of residents in the Kiama area. Reverend the Hon. F. J. Nile made some reference to the extent of demand during peak and holiday periods. Figures taken out in December 1990, which is a holiday period, show that only 221 people attended for accident and emergency service - in other words, to seek treatment from the nurses. That is an average of about seven people a day. In January 1991, 254 people attended the hospital - an average of seven and a half patients a day. They were seen by nurses and, where necessary, services were provided by general practitioners, either by referral to the general practitioners or when the general practitioners visited the hospital.

Reverend the Hon. F. J. Nile: We are not happy with that situation.

The Hon. J. P. HANNAFORD: It is a matter of making certain the information is available. The local general practitioners provide GP services. The level of care is so low that one might well question whether or not it is optimal care. I make it clear to the House that the people of New South Wales want reasonable access to quality health services. Beds are not health services; buildings are not health services. Quality health services must be reasonably available. In 1986-87, under the Wran Labor Government, obstetrics and surgery services were no longer available and the operating theatre was closed. At that time the hospital lost 39 beds. After that action, its role as an acute hospital ceased. Kiama hospital was providing slowstream, long-term care for Kiama residents as well as residents from other parts of the Illawarra. The downgrading marked the beginning of the end for Kiama hospital as the focus of acute and emergency health care for residents in the Kiama municipality. As honourable members have indicated and acknowledge, it was the decision of the Labor Government which rang the death knell for that particular facility. The changes coincided with the commissioning of acute services at nearby Shellharbour hospital. Services provided by the 124-bed Shellharbour hospital include surgical and medical services, accident and emergency and obstetrics services, as well as inpatient-outpatient acute psychiatric care. Under normal circumstances that hospital is less than 15 minutes away by road from Kiama - much less by ambulance.

Reverend the Hon. F. J. Nile: It used to have a children's ward.

The Hon. J. P. HANNAFORD: Yes, it was closed seven years ago. Because of improvements in efficiency through the New South Wales health system Shellharbour hospital has been underutilised, with bed capacity in excess of the demands of its catchment area. A 1992 independent analysis of the health services in the Illawarra region, carried out by Reid Harris and Associates, examined the current arrangements for the provision of hospital services for the population of the area. The report proposed strategies to best meet health needs for the nineties and on into the next century - that is,
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concentrating on the provision of services. In making its recommendations, the report urged that strategies should be developed to make further use of the Shellharbour hospital, and pointed to significant problems with the financial and planning arguments for continuing with the proposal for privatising Kiama hospital.

Addressing this issue should be a matter of importance to this House. I emphasise that the Opposition has fallen into a classic trap of measuring the performance of the New South Wales public health system by referring to the numbers of beds, not the number and types of services which should be provided. What is vital to this issue is that there has been no change to the number and quality of health services available to the Kiama community. Acute care services ceased to be provided in 1985-86 under the Wran Labor Government, when the then health Minister, the present member for Liverpool, reconstructed Kiama hospital. The Opposition was obviously not concerned at that stage that it was an issue because, quite rightly, services were available at nearby Shellharbour hospital. In reality, this matter of public importance relates to the relocation of services provided by 13 slowstream beds from an ageing hospital needing significant expenditure, to a new, state-of-the art hospital 15 minutes away.

The action taken by the Illawarra Area Health Service was sensible and rational, and, above all, was taken in the interest of providing the best quality of health services for the Illawarra community. It is vital that honourable members fully understand the context of the recent decision by the board of the Illawarra Area Health Service to close that hospital. I wish to comment on the remarks of Reverend the Hon. F. J. Nile and the Hon. Elaine Nile, who I know are genuinely interested in the expansion of health services and in ensuring that those services are readily and reasonably available. I also know they are supportive of the joint venture public hospital approach being taken in Port Macquarie. That is why they have advocated a similar proposal for Kiama. I draw the attention of the House to the reasoning for that approach. Such a private hospital has to be licensed, under the Private Hospitals and Day Procedure Centres Act. That Act defines a number of set standards which must be met before a licence will be issued. Kiama hospital, as a public hospital - at the present time and when it was operating - does not and did not comply with the standards required of a private hospital, should it be the subject of a joint venture proposal.

It is interesting to note the approach taken by the Labor Party. It insists on the retention of hospitals which do not meet current standards required of the private sector. To bring Kiama hospital up to that standard, several hundred thousand dollars, possibly up to one million, would need to be expended - to bring a 13-bed facility up to the standard to enable it to be licensed in accordance with the current health standards provided by the Private Hospitals Act. The Opposition has suggested, in relation to this particular proposal, that the Government should trial the co-operative's approach over a two-year period, and allow a joint venture public hospital to operate. The Government must either do that on a permanent basis or not at all, because a two-year period will not be sufficient time to recoup the investment. The Government would have to make a decision whether or not to buy services from such a hospital under a contract of service, which is the contract before the Public Accounts Committee in another place. [Time expired.]

The Hon. DOROTHY ISAKSEN [11.46], in reply: I thank honourable members for participating in this debate. The reason I brought the debate on today was because I believe the people of Kiama are owed an opportunity to air their grievances over the
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loss of their hospital. For six years the Government promised that the hospital would be maintained. The Opposition has used the term "another broken promise" and the people of Kiama feel they have been betrayed by the Government because they were assured by the present Premier, when he was Leader of the coalition Opposition, that the hospital would remain open. Also, prior to the elections in May last year, the then Minister for Health, Peter Collins, gave an absolute assurance that the hospital would remain open. It is interesting to note that, less than 12 months later, the present Minister says the hospital is old and rundown, and a lot of money would need to be spent to maintain it. Surely the condition of the hospital has not changed so much in 12 months. Clearly the Government is looking for excuses to justify the fact that it has changed its mind over this period. The Hon. Elisabeth Kirkby referred to the geographical problems of the area. I do not know whether the Minister for Health and Community Services has spent any time on the roads in the area, but -

The Hon. J. P. Hannaford: I was there over Easter, at the worst time.

The Hon. DOROTHY ISAKSEN: That is right. The Manly-Warringah peninsula has a similar problem: only one main road provides access to medical facilities.

Reverend the Hon. F. J. Nile: A single-lane road.

The Hon. DOROTHY ISAKSEN: That is right. In holiday periods motorists experience many traffic jams, making it difficult to travel from point A to point B. This can cause problems particularly for elderly people and asthmatic children seeking emergency health services. The people of Kiama want to retain their community hospital, which they have built up throughout the past 102 years. Over the years criticism has been made about Kiama District Hospital's incorporation into the Illawarra Area Health Service. I do not disagree with that move. However, the people of Kiama wish to preserve their security and retain their hospital. As the strategic statement revealed, Kiama has an increasing population of elderly people to whom the hospital represents security should they require urgent medical treatment. The Hon. Elaine Nile spoke about the efforts of members of the community to retain the hospital and the repeated assurances by the Government that the hospital would not be lost to them. Several local meetings attended by about 700 people have brought the community together in an effort to try to save the hospital. I resent the way the Minister for Health and Community Services has verballed us and sought to compare the Kiama District Hospital proposal with the Port Macquarie hospital proposal. That is a totally different situation.

The Hon. R. B. Rowland Smith: Why?

The Hon. DOROTHY ISAKSEN: The hospital at Port Macquarie exists and is working well whereas the Kiama District Hospital has been closed. A number of scenarios have been suggested. The best scenario is that Kiama District Hospital be allowed to remain open. The worst scenario is the current situation: no hospital at all. The community has put forward the proposition that it run its own hospital - a totally different proposal from that in Port Macquarie where a private company is seeking to manage the hospital. The Kiama co-operative proposes that the people themselves run the hospital. They are the ones who should say how the hospital should be run. The organiser of Kiama Community Hospital Co-operative Limited, with whom Reverend the Hon. F. J. Nile has had some contact, pointed to a number of agreements in the lease about which assurances have been given to the Illawarra Area Health Board. The agreements were that the hospital co-operative must maintain the premises to the standard required by the Illawarra Area Health Board; the board will have the right to enter the premises at any time for inspection; the co-operative must indemnify the Illawarra Area
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Health Service against all actions; the co-operative maintain a standard of care which the Illawarra Area Health Service must monitor; the co-operative must maintain accreditation status throughout the term of the agreement; and the co-operative must institute a system to survey patients' satisfaction, which is to be approved by the Illawarra Area Health Service.

The Hon. Dr B. P. V. Pezzutti: Does the honourable member want everything to be owned by the State?

The Hon. DOROTHY ISAKSEN: Public hospitals should be owned by the State, not handed over to private organisations. This debate, if anything, has achieved -

The Hon. Dr B. P. V. Pezzutti: It has been a waste of time.

The Hon. DOROTHY ISAKSEN: It has not been a waste of time. When I asked the Minister what is to happen to the Kiama District Hospital he gave an assurance that the Government will not sell the hospital. The debate achieved that, therefore it has been worthwhile. The Minister has assured me that the hospital will be retained and maintained for hospital services. I thank honourable members who participated in the debate. Something worthwhile has been achieved for the people of Kiama.