Full Day Hansard Transcript (Legislative Council, 17 November 2004, Corrected Copy)

LEGISLATIVE COUNCIL

Wednesday 17 November 2004
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The President (The Hon. Dr Meredith Burgmann) took the chair at 11.00 a.m.

The Clerk of the Parliaments offered the Prayers.

THREATENED SPECIES LEGISLATION AMENDMENT BILL

Message received from the Legislative Assembly agreeing to the Legislative Council's amendments.

AUDITOR-GENERAL'S REPORT

The President tabled, pursuant to the Public Finance and Audit Act 1983, the report entitled "Auditor-General's Report—Financial Audits—Volume Four 2004", dated November 2004.

Ordered to be printed.

BUSINESS OF THE HOUSE

Precedence of Business

Motion by the Hon. Tony Kelly agreed to:

STANDING COMMITTEE ON LAW AND JUSTICE

Reporting Date

Motion by the Hon. Christine Robertson agreed to:

PETITIONS

Disability Programs Funding

Petition requesting a guarantee that the quality of services offered by the Post School Options and Adult Training, Learning and Support programs will not be reduced through funding cuts or restructuring, received from Ms Sylvia Hale.

BUSINESS OF THE HOUSE

Withdrawal of Business

Private Members' Business item No. 94 outside the Order of Precedence withdrawn by the Hon. Christine Robertson.

BUSINESS OF THE HOUSE

Postponement of Business

Government Business Notices of Motions Nos 1 and 2 postponed on motion by the Hon. Tony Kelly.

Budget Estimates 2004-05—Take-note debate postponed on motion by the Hon. Tony Kelly

Committee Reports Orders of the Day Nos 1 to 3 postponed on motion by the Hon. Tony Kelly.

GENE TECHNOLOGY (GM CROP MORATORIUM) AMENDMENT BILL

In Committee

Consideration resumed from 16 November.

The Hon. IAN MACDONALD (Minister for Primary Industries) [11.09 a.m.]: I move:

The Hon. PETER PRIMROSE [11.09 a.m.]: I move:

Amendment agreed to.

Motion as amended agreed to.

Mr IAN COHEN [11.10 a.m.], by leave: I move Greens amendments Nos 1, 2 and 3, which were circulated as Government amendments:

No. 1 Page 3, schedule 1 [2], proposed section 8 (6A) as inserted in committee. Omit the subsection.

No. 2 Page 3, schedule 1 [3], proposed section 9 (1A) as inserted in committee. Omit the subsection. Insert instead:

(1A) In the case of an exemption order, the Minister is to cause details of the precise location of the area of land to which the exemption order relates:

(a) to be published with the notice of the order, and

(b) to be forwarded to each of the following:

(i) the local council for each local government area in which GM food plants are to be cultivated under the order,

(ii) the rural lands protection board for each district in which GM food plants are to be cultivated under the order,

(iii) any other persons or bodies prescribed by the regulations.

No. 3 Page 3, schedule 1. Insert before line 34:

[3] Section 9 (2)

Insert "or (1A)" after "subsection (1)".

These amendments are simply machinery amendments to clean up some of the wording, particularly in proposed section 9 (1A), in line with an intent that was clearly stated in Committee last night. They clarify the confusion in drafting between The Nationals and the Greens late last night. I commend the amendments.

The Hon. IAN MACDONALD (Minister for Primary Industries) [11.11 a.m.]: The Government supports these amendments. It notes that the sentiments in the amendments are the collective wisdom of not only the Greens but also The Nationals and the Government.

[Interruption]

I will not let the Hon. Dr Peter Wong get carried away, but those sentiments were conveyed in the Government Gazette of 25 May this year, when I issued the exemption orders. Indeed, all of these matters are contained in the Government Gazette. The Government always intended to do this.

The Hon. DUNCAN GAY (Deputy Leader of the Opposition) [11.12 a.m.]: I support these amendments, which reflect the views of the Greens and The Nationals. When Mr Ian Cohen asked me this morning if I would allow him to move the amendments, I did not realise he would move them as Greens amendments. However, if that is what he wants to do, that is fine by me.

Mr Ian Cohen: What should I have moved them as?
The Hon. DUNCAN GAY: They are circulated as Government amendments.

The Hon. Ian Macdonald: I have acknowledged that.

The Hon. DUNCAN GAY: Yes. The Minister opposed these amendments yesterday, but I am pleased that he has come on board today.

The Hon. Dr PETER WONG [11.13 a.m.]: I congratulate all parties on their spirit of unity.

Amendments agreed to.

Reconsidered schedule 1 as amended agreed to.

Bill reported from Committee with amendments and report adopted.

Third reading ordered to stand as an order of the day.

HEALTH LEGISLATION AMENDMENT (COMPLAINTS) BILL

HEALTH REGISTRATION LEGISLATION AMENDMENT BILL

NURSES AND MIDWIVES AMENDMENT (PERFORMANCE ASSESSMENT) BILL

Second Reading

The Hon. IAN MACDONALD (Minister for Primary Industries) [11.15 a.m.]: I move:

To inform honourable members of what this legislation is about, I will read the explanatory note to the bill:

Health Care Complaints Act 1993

the Principal Act

(a) to enable the Health Care Complaints Commission (the Commission) to focus on dealing with serious complaints concerning health practitioners, health service providers and the provision of health services, and—

(b) to establish the Health Conciliation Registry as a separate unit within the Commission to deal with the conciliation of complaints, and

(c) to enable the Commission, in appropriate circumstances, to deal with complaints through alternative dispute resolution procedures, and

(d) to require the Commission to appoint a member of staff as Director of Proceedings to exercise the function of the Commission of determining whether a complaint should be prosecuted before a disciplinary body.

I seek leave to have the remainder of the second reading speech incorporated in Hansard.

Leave granted.

The Hon. ROBYN PARKER [11.18 a.m.]: I am well aware of the purpose of the Health Legislation Amendment (Complaints) Bill and cognate bills, which implement the recommendations of the Special Commission of Inquiry into Campbelltown and Camden Hospitals and the review of the Health Care Complaints Act 1993 undertaken by the Cabinet Office. In many ways, we are disappointed that the Health Care Complaints Commission inquiry went down the path it took, because we felt that a royal commission of inquiry into the Government's operation of health matters, and the handling of complaints in particular, was necessary.

The problems are much broader than Camden and Campbelltown hospitals. Commissioner Walker's recommendations are sound. Clearly, there are systemic problems across the board in NSW Health; they are not restricted to two hospitals or one area. Commissioner Walker recommended that unsatisfactory professional conduct be refined so that only significant incidents that involve a lack of skill, judgment, or care result in investigation or disciplinary action. That will put parameters around the complaints mechanism so it is clear what the role of the Health Care Complaints Commission [HCCC] is, what the role of health care complaints are, and how serious complaints can be investigated.

Clearly, registration boards have a greater part to play. As a member of the committee that investigated the complaints concerning Camden and Campbelltown hospitals, I clearly understood that currently there is no culture within NSW Health that encourages complaints or encourages the appropriate management of complaints from individuals or groups. It was very clear that the registration boards, particularly the Nurses Registration Board, did not have responsibility for continuing professional education and assessment of professional behaviour.
That said, an important point needs to be made. The inquiry focused largely on systemic problems rather than on individuals. If the system encourages complaints, if the system encourages full disclosure, if the system is established in a way that whistleblowers have protection and support, it will be a much more effective incident-handling system. People will be encouraged to learn from mistakes and ensure that serious problems arising from mistakes are dealt with and that systems are established so they do not occur again. It should be said also that professional errors and misconduct need to be dealt with, and there needs to be a facility that looks at the individual professional misconduct or lack of ability when it comes to mistakes.

I note that the Pharmacy Board of New South Wales and the Australian Psychological Society raised concerns about assessing unsatisfactory professional conduct by reference to other practitioners. There was quite a lot of concern about the level of training and whether a practitioner who has only just commenced practice should be held to the same standard as someone more experienced. I note that all practitioners need to meet entry-level standards in order to be registered. In his recommendations Commissioner Walker sought to give the HCCC greater flexibility in dealing with complaints.

In her discussions with our committee that was investigating complaints, Commissioner Amanda Adrian acknowledged on many occasions that her attitude to dealing with complaints was to look at systemic problems. Very clearly the Health Care Complaints Commission was not sufficiently resourced by the Government to deal with some serious complaints. Had it had the resources when the whistleblower nurses made complaints about Camden and Campbelltown hospitals, perhaps things would have been different, perhaps they would have been dealt with; but the HCCC was completely swamped when it came to trying to deal with these problems and it would seem that it did not have the capacity to deal with them at the required level. So any improvement in resourcing the HCCC is most welcome.

The other improvements that are welcome are the amendments relating to the supervision of professions such as nurses and midwives. The new objects of the HCCC emphasise that its primary role is the investigation of serious complaints. These organisations have a supporting role, and Commissioner Walker particularly praised the Medical Board for the way it handled complaints. I would like to see the Nurses Registration Board do more than just process members' applications each year and tick them off without taking responsibility in the way the Medical Board does when handling complaints. Commissioner Walker recommended that performance assessments be introduced by the nursing profession, and that should be wholeheartedly supported.

The bills also include a requirement for the HCCC to have regard to the protection of the public when exercising complaints handling and other functions. This brings it into line with the health professionals registration Acts, which have a particular public protection focus. A further purpose of the bills is to improve the complaints-handling process. It was clearly evident from our inquiries that people need to know where to make complaints, how to make complaints, and what processes to follow-up. When the HCCC investigates complaints it has to be empowered to require relevant people to provide documentation. Concerns have been raised about freedom of information, and I think the Minister addressed some of those issues in his second reading speech.

I note the Minister's comments about encouraging people with poor literacy skills and people from linguistically diverse backgrounds in order to give them an opportunity to present a complaint without having to go through a statutory declaration requirement. Once again, the Opposition has concerns about creating an independent office of the Director of Proceedings in the HCCC. With all the health legislation currently before the House—and all the rhetoric that we are reducing bureaucracy, adding efficiencies and putting more funds into front-line health—there is concern that this is inserting another layer of bureaucracy. Perhaps the director should be appointed by the Minister so he or she is independent. I note that the Director of Proceedings needs to consult with relevant registration boards about their views before deciding to implement disciplinary proceedings.

Another aspect of our inquiry was root-cause analysis. The root-cause analysis provisions will be introduced based on the quality assurance provisions in the Act, to protect the information that is provided to root-cause analysis teams. Root-cause analysis is an important tool in ensuring that the causes of adverse events are properly identified. It also creates a culture of learning and makes individuals feel part of a team to determine what went wrong, who is responsible, what procedures could be implemented in future, further ways of learning from that, and improving the system outcomes.

Other members will refer to complaints handling within the hospital environments they deal with. Substantial system breakdown in complaints handling has occurred across the board and we have a long way to go with the public health system in New South Wales. The problems are much broader than the issues investigated by the committee in relation to Camden and Campbelltown. The Minister and the Premier said over and over again that the problems there were isolated and unconnected with problems in other hospitals and other parts of the health system. Mr Walker's terms of reference were therefore extremely narrow. Even during the time of the Walker inquiry, and since, we found continuing examples of problems. We do not oppose the bill; we support the wider community having more opportunity to participate, to be consulted and to feel included. It can be difficult to formulate legislation providing for the maintenance of professional standards that are easily met without excessive red tape and the required professional protection within a system that the general public can have confidence in.

I note that the Australian Medical Association was consulted and contributed comments about the bill. It supports the suspension of any practitioner whose conduct breaches professional standards. The association was concerned about the mixture of legal representation and non-legal representation. Most practitioners would have legal representation and the association was concerned about having two different groups involved in very serious complaints, thereby complicating the situation with regard to the right to have legal support. Members in this Chamber and in another place have acknowledged the bravery of the whistleblower nurses at Camden and Campbelltown.

I wonder whether we would be in the present situation had they not risked their professional lives by making the Government tighten up complaints-handling procedures. In some cases they are finished in the medical profession. We owe them a great debt. The bill improves the regulation of the Health Care Complaints Commission, with support from the Nurses Registration Board. It provides review, assessment and discipline in a constructive way. I hope that the commission will be better resourced than it was when Amanda Adrian was appointed commissioner. Other Opposition members will contribute further on protection of whistleblowers, the Walker inquiry, operations of the HCCC, complaints-handling management, and assessment and regulation of the performance of professionals within the health care system. I look forward to their contributions.

The Hon. Dr PETER WONG [11.38 a.m.]: I speak to the Health Legislation Amendment (Complaints) Bill and cognate bills as a member of the joint parliamentary Committee on the Health Care Complaints Commission and as a professional in the medical field, so I have an interest in the commission and the principal bill. The invaluable work of the Committee on the Health Care Complaints Commission obviously lies behind many of the provisions of the bill. Combined with the draft exposure process, the bill goes a long way to improve the complaints-handling processes in this State. This is very important for the citizens of New South Wales, because without a workable and practical complaints process the problems that have come to affect the health system in this State, as exemplified by the Campbelltown and Liverpool hospital crisis, are less likely to be recognised and rectified. The public should be reassured that improvements in the health care system are more likely to occur simply because of the changes introduced by the bill. That said, however, we must all continue to monitor the Health Care Complaints Commission [HCCC] and its impact on the health system to ensure that a process of reform continues to deliver real benefits to the people of New South Wales.

Although the Government has adopted many of the committee's recommendations over the years, unfortunately some equally important recommendations have not been adopted. Those recommendations should be reconsidered by the Government and, more importantly, by members of the general public. This is especially pressing because we will soon see the outcome of Presland v Hunter Area Health Service and, with it, the departure of yet another oversight mechanism designed to monitor this Government's lack of responsibility. As such, the public will depend more and more on the HCCC to ensure their health system improves. Therefore, I wish to bring to honourable members' attention areas that require ongoing improvement to ensure we get the levels of service we deserve.

It is regrettable, as mentioned by the honourable member for Lake Macquarie, the chairman of the Committee on the Health Care Complaints Commission, that the Health Conciliation Registry will be incorporated into the Health Care Complaints Commission. This is not something I support, nor is it likely to improve the HCCC process. The Health Conciliation Registry is designed to enable parties involved in a complaint to discuss the matter and to agree on possible options for resolution of the complaint. To achieve this it is supposed to be neutral and non-threatening and, most importantly, not part of the investigation process.

Having the conciliation process under the control of the HCCC creates the perception that it fails to meet these important aspirations. This will have a major impact upon the HCCC because many of the individuals who previously would have undergone conciliation will not do so under the proposed model. That will push extra work onto the HCCC and slow down the complaints process. That result will be contrary to the rationale for this bill. As I have explained, it is highly unlikely that giving the conciliation process to an agency with incredible powers of investigation and prosecution will achieve the results the Government expects it to, let alone preserve the separation of powers that citizens reasonably expect to be preserved by the Parliament.

Another matter requiring the urgent attention of the HCCC and the Government is that members of the Medical Board and the Medical Tribunal require more legal training. This is important because doctors who are members of those bodies generally have only medical training and that has an impact on their ability to extract the information that is required to make important decisions. A simple problem is that Medical Board members ask leading questions. While this is most likely unintentional, the outcome is often not what could be considered best practice. For example, a member might ask, "Doctor don't you think that the action you took was wrong?" That is likely to result in totally different evidence than a question such as, "Doctor, will you explain why you have taken this action?" A small amount of additional training in this regard will deliver greater efficiencies and fairness in the administration and delivery of health services. I am a member of a Federal professional review tribunal and all members are required to undergo medico-legal training either annually or bi-annually.

As mentioned in the committee's report, the lack of cultural diversity at board level should be examined. I hope that the Minister and the director-general will do that in the near future. Although I have mentioned some important concerns, the bill is generally very good. It will bring about improvement, not only to the health complaints process but also, by default, to the provision of health care in this State. Very important issues have been addressed by the bill, such as excluding members of the Medical Board from sitting on the Medical Tribunal and the Professional Standards Committee. The Committee on the Health Care Complaints Commission previously made recommendations about this issue because there were strong fears in the community that this practice led to the perception that the adjudication process was not impartial. Certainly, many practitioners believed that such impartiality existed. By adopting the committee's recommendations in this regard the Government has brought New South Wales legislation into line with the legislation in other States and, importantly, has standardised New South Wales practice for other medical practitioners such as dentists.

The New South Wales process of having parliamentary committees oversighting watchdog agencies can be useful in bringing about valuable changes. Although the public should maintain a healthy scepticism about political watchdogs watching over the public watchdogs, many will agree that at least with the Committee on the Health Care Complaints Commission we are getting that process right. That it has been a bipartisan committee is evidenced by many of the improvements that this bill seeks to introduce. I mention this to voice my respect for the work of the members of that committee both past and present and, in particular, the chairman, Mr Jeff Hunter.

I take this opportunity to thank Western Sydney general practitioner Dr Sabag and his supporters, who brought to the committee's attention inadequacies, biases and many unfair practices with regard to the HCCC. They also highlighted some inadequacies of the Medical Tribunal. The committee took notice of Dr Sabag's input, which made a significant contribution to the recommendations. Former member the Hon. Dr Brian Pezzutti has also done a great deal to assist the committee. Finally, I disagree with some comments made by the Hon. Robyn Parker about the HCCC. The Committee on the Health Care Complaints Commission is almost a non-political committee. In fact, its recommendations were unanimous.

Amanda Adrian was incorrect when she said that the Government did not provide enough resources. The resources were supposed to be provided by the HCCC and the funding was provided by the Government. The Government provided more funding than was required at the time. From the submissions received by the committee, including from the Medical Board of New South Wales, the Australian Medical Association, the medical defence organisations and many individual doctors, it is clear that almost no-one supported Ms Adrian. In fact, the majority were very critical of her and her leadership.

The Medical Board highlighted that the HCCC has a lack of medical knowledge and indicated it was willing to help, but that suggestion was not taken up. There were long delays in the investigation of the incidents at Campbelltown and Camden hospitals. I am not saying that the Government was right. In fact, I agree with the Hon. Robyn Parker—it is a systemic problem. However, as a committee that monitors and supervises the HCCC, we are aware that the long delay in delivering the funding was not the Government's fault entirely. I believe this legislation will improve the health system in New South Wales and I congratulate the Government on this bill.

Ms SYLVIA HALE [11.49 a.m.]: The Greens support the Health Legislation Amendment (Complaints) Bill. Proposals to standardise the definitions of professional misconduct across the professions are a commonsense and well thought-out reform. The integration of the Health Conciliation Registry into the Health Care Complaints Commission [HCCC] will not diminish the statutory independence of the body, and may help to deal with the conciliation of complaints in a more integrated fashion. Any step that gives improved institutional support and assists more parties to work towards conciliation rather than litigation is welcome.

New requirements that complaints against a medical practitioner be given in writing to both the practitioner concerned and the employer appear both fair and in keeping with current good practice and complaints policies in other professions. The Greens support the stated objectives of the bill to refocus the activities of the HCCC on the investigation of serious complaints. How this will be achieved is the challenge. One of the criticisms levelled at the HCCC has been the excessive delay in investigating claims. More powers without more funding to carry out investigations will do little or nothing to address this problem. The delays, where they occur, relate primarily to inadequate resourcing. Any complaints and investigation process is reliant on having sufficient staffing and resourcing to be effective. Legislative power to access information and people is important, but adequate staffing, training and administrative support are vital.

Against this backdrop, increasing the powers of the HCCC to investigate allegations of serious misconduct sounds like a good idea, but powers alone will not be sufficient. The Greens support the new Director of Prosecutions in the HCCC; however, to be effective it too will need to be funded adequately. What we see in these three bills is the culmination of the debacle at Camden and Campbelltown hospitals. We have all heard appalling tales of maltreatment at Camden and Campbelltown—whether from hyperventilated media reports or from letters from constituents. There is no doubt that people died unnecessarily and in tragic circumstances due to problems at these two hospitals. The Greens' support and sympathy for the families of those people is complete and unconditional.

One of the Opposition speakers in the Legislative Assembly suggested that central to the problems at Camden and Campbelltown hospitals was a fundamentally flawed Health Care Complaints Commission. The Greens dispute this. Pointing the finger of blame at the HCCC for systemic flaws in the medical system is a game that the Government, the Opposition, and the radio shock jocks have all played. It is a cheap and easy game to play, but it fails to get to the real source of the problem: underfunding of our hospitals. Vast sums are spent on flash buildings and the latest technology, but all this means nothing if we fail to provide sufficient resources for the people who use those facilities. It is doctors, nurses, cleaners and technicians that our hospitals are crying out for. What the health system desperately needs is more staff.

The HCCC under the leadership of Amanda Adrian had a policy of accepting and sharing responsibility for problems. It is untrue to assert, as the Opposition and the shock jocks have, that responsibility was not accepted. The approach of the HCCC not to victimise and attack individuals but to treat the problem as a system breakdown is a well accepted and respected management approach. That is not to say there are not problem individuals who weaken the chain, but attacking and demonising individuals is never an effective method of fixing complex system-wide problems. This is not what senior managers and Ministers like to hear. It is far easier to sack someone than it is to examine why and how problems evolved. But it is only by addressing the underlying problem of insufficient staffing that our hospitals system will be fixed.

Due to the courage of the nurses who raised the alarm, and the herculean effort by staff at Camden and Campbelltown hospitals since, problems were identified and operational solutions devised. Unfortunately, they did this in a climate of hysteria and blame shifting. This is precisely what the HCCC sought to avoid. I was talking to a worker in this Parliament only last week about the exemplary medical service a family member had received recently when giving birth at Camden hospital. The staff at the birthing centre were friendly, helpful and highly professional in every possible way. It is important to tell the stories of the hundreds of thousands of people who receive exemplary medical care from our public hospitals every year. Staff working in our hospitals must be congratulated on the extraordinary job they have done, and continue to do, under extreme pressure.

But that is not to gloss over the problems. Unfortunately, this bill will do almost nothing to meaningfully tackle the systemic and underlying problems afflicting the health system. It will fail to achieve its stated goals of better protecting the public against a flawed medical system unless the HCCC is provided with sufficient funding. More legislative power alone will not fix the current woes of the health system. This bill is no silver bullet—much though the Government wishes it were. Commissioner Walker did not find the HCCC fundamentally flawed or lacking teeth; he found its statutory powers generally sufficient. But the Government has to be seen to be doing something, and increasing the powers of the HCCC is a far easier and less costly option than actually addressing the underlying problems: insufficient staffing and staff support. As noted by other speakers, consumer stakeholders and the medical profession have been broadly supportive of the amendments in these three bills. The Greens do not think that increased powers of the HCCC will fix the problems in the health system. These are far more systemic. Nevertheless, the Greens support the bill.

The Hon. Dr ARTHUR CHESTERFIELD-EVANS [11.56 a.m.]: These bills are largely the result of inquiries into Camden and Campbelltown hospitals. Those inquiries were the result of allegations made, successfully and persistently, by the so-called whistleblower nurses, Nola Fraser and her colleagues. It might be noted that those nurses are still not working and are still, quite frankly, not likely to be working within the New South Wales health system. The degree of rupture of their trust is basically unfixable. They have paid with their careers and, in some cases, with their marriages, because of the stress. It is a poor show when a person such as Nola Fraser runs a beauty parlour rather than works as the competent nurse she is.

The Government was not very keen to conduct inquiries to the extent that it has. Allegations were made to the Independent Commission Against Corruption about the conversation between the whistleblower nurses and the Minister, and the Health Care Complaints Commission [HCCC] inquiry was ongoing. I believe that the Walker inquiry would not have happened had the Government not been faced with my motion to conduct an inquiry through a parliamentary committee. I told the Government that I had the numbers for a parliamentary inquiry into the situation at Camden and Campbelltown hospitals but that if the Government produced a judicial inquiry—which of course would have more time and resources available to it—I would not ask for a select committee inquiry. The Government, to its credit—if that is the word—conducted the Walker inquiry. That inquiry had quite limited terms of reference, which I believe was an error, but Walker said he was unable to give more time to the inquiry thane did. Perhaps that is true.

Since the inquiry a number of people in different hospitals have said to me, "We are glad the Camden and Campbelltown inquiry did not happen in our hospital, because we have all the same systemic problems that they have". General Purpose Standing Committee No. 2 also had an inquiry into health complaints and, again, that was a compromise between the Opposition, which wanted a very extensive inquiry, and the Government, which wanted no inquiry. I basically got terms of reference that I thought would be realistic for that committee.

It is a bit churlish that the Minister did not refer in his second reading speech to the work of the committee and its report. Suffice it to say that the efforts of the whistleblower nurses, their personal selflessness and the political and media consequences of their persistence and courage have resulted in the health system being thrown into the public spotlight. These bills and the changes within the health system are part of that process. It is interesting that the Government, when put under pressure, sacks somebody and introduces legislation.

Pursuant to sessional orders business interrupted.

QUESTIONS WITHOUT NOTICE

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CITYRAIL EMERGENCY EGRESS POLICY

The Hon. MICHAEL GALLACHER: My question without notice is directed to the Minister for Transport Services. What is the outcome of the review announced by Vince Graham nearly six months ago into CityRail's policy to lock passengers in trains in an emergency situation until they are released by the driver or guard? Can the Minister inform the House of one other large metropolitan rail service comparable with Sydney, anywhere in the world, that locks passengers in rail carriages in the event of an emergency?

The Hon. John Ryan:. Good question.

The Hon. MICHAEL COSTA: Yes, it is a good question. A review is under way on what is commonly referred to as egress from rolling stock. That is also part of the Waterfall processes, and I would expect that we would wait until the Waterfall inquiry makes its conclusions before a final public statement is made on the position. There is debate about the correct approach in these matters. It is not a clear-cut solution. Each circumstance has advantages and disadvantages. Only recently we had a situation on our system where, because a train was delayed, people tried to hop off the train and were collected by another train. It is not a simple question of what is the right strategy. We need to broach it on a risk-management basis and adopt the best solution. It may well be that the solution is the current one or that a different solution is necessary. We are not going to rush into it. It is going to be done properly.
The Hon. Michael Gallacher: Can you give us one other instance elsewhere in the world?

The Hon. Duncan Gay: Name one.

The Hon. MICHAEL COSTA: This is a serious matter. I am not going to play games with it, as Opposition members are doing. They know that the Waterfall inquiry is looking at the matter. I do not intend to make any comments about it until after the inquiry makes its conclusions.

The Hon. Michael Gallacher: So you don't know. I asked you for one other comparable rail system. You are not breaching Waterfall or anything else.

The PRESIDENT: Order! I call the Leader of the Opposition to order.

The Hon. MICHAEL COSTA: You ought to call him to order, Madam President, because he has run out of questions to ask me.

The Hon. Michael Gallacher: You said it was a good question.

The Hon. MICHAEL COSTA: Certainly it is a good issue but we are not going to pre-empt Waterfall. The commission of inquiry is looking at this matter and it is completely appropriate that Waterfall be allowed to continue its process.

DANGEROUS GOODS STORAGE AND TRANSPORT

The Hon. PETER PRIMROSE: My question without notice is directed to the Minister for Commerce. Can the Minister please explain how the Government is informing the community about the safe storage and transport of dangerous goods?

The Hon. JOHN DELLA BOSCA: The New South Wales Government has announced a series of free public seminars to explain proposed changes to laws covering explosives, dangerous goods and major hazard facilities. The first in a series of seminars was held last week at Gosford, around the corner from the head office of WorkCover NSW. Seminars will be taking place until early December in 21 locations around New South Wales, from Albury to Tweed Heads. This week we have had seminars in Newcastle, Maitland, Orange and Tamworth.

The two-hour seminars cover risk management and risk communication, controls which minimise the likelihood of a chemical incident, emergency preparedness and responses to a chemical incident, and checks and controls for security-sensitive materials. Highly qualified WorkCover personnel who have extensive experience in chemical management, dangerous goods, hazardous substances and major hazard facilities will present the seminars. To improve safety and security WorkCover is working with other government agencies, employers, unions and the community to update the State's chemical management laws. The changes are aimed at reducing death, injury and illness arising from the storage and handling of dangerous goods.

We are overhauling the controls governing chemical risks, and emergency readiness and responses to chemical incidents, to better protect people, property and the environment. WorkCover has already written to the 12,000 dangerous goods licence holders in New South Wales. We also expect that the seminars will be of interest to farmers, horticulturalists and those who deal with commercial quantities of fertiliser. The new requirements for the regulation and control of dangerous goods in New South Wales are designed to ensure a nationally consistent approach, as well as addressing concerns about the safety and security of dangerous goods facilities. The current Dangerous Goods Act 1975 and Dangerous Goods Regulation 1999 will be replaced by two new regulations under the Occupational Health and Safety Act 2000 and the new Explosives Act 2003. The two-month public comment period for the new regulations will begin later this year.

The Hon. Rick Colless: More regulations.

The Hon. JOHN DELLA BOSCA: I think these regulations are a good idea. Dates and locations of the public information sessions are available on the WorkCover web site and bookings to attend the sessions can be made on 1800 242 200.

NOXIOUS INSECT FUND

The Hon. DUNCAN GAY: My question is directed to the Minister for Primary Industries. Now that $7.1 million of Noxious Insect Fund moneys paid by farmers has been spent as of November this year can the Minister inform the House how much money is actually left in the fund? When will the Government put more of its own money into controlling the locust program?

The Hon. Michael Gallacher: I wouldn't be using that as a prop if I were the Minister. He looks like Elmer Fudd, and it is not rabbit season, it is locust season.

The PRESIDENT: Order! The Minister has the call.

The Hon. IAN MACDONALD: I was happy to listen to that. The honourable member asked me a question about funding. It is clear that issues will need to be addressed in the coming period. It is estimated that the department is spending about $2 million in funding the campaign against locusts. In fact, much of the funding has come from the Noxious Insect Fund. However, the Government will have to reconsider measures next year in terms of how the fund shortfall will be addressed.

The Hon. Duncan Gay: Are you going to answer the question or are you going to ponce around?

The Hon. IAN MACDONALD: That is the answer. The locusts program in this State has been carefully assessed and at all steps endorsed by the Rural Lands Protection Board and New South Wales farmers.

The Hon. Duncan Gay: How much money is left and when are you going to spend your own?

The Hon. IAN MACDONALD: Each outlay that we have made along the line has been well and truly assessed. Just recently we bought about $600,000 worth of chemicals and I authorised that purchase on the basis of correspondence from all parties involved, including the Rural Lands Protection Board. Once we have won the fight we will assess, with the parties, how we will raise the required moneys.

The Hon. Duncan Gay: Stop spreading the bulldust. Answer the question.

The Hon. IAN MACDONALD: I have, totally.

BELMONT HIGH SCHOOL YEAR 10 FORMAL

The Hon. JOHN TINGLE: My question without notice is addressed to the Treasurer in the absence of the Minister for Community Services, representing the Minister for Education and Training. Is it a fact that year 10 students at Belmont High School, near Newcastle, are having their formal next Tuesday night and that the school has declared that students whose parents have not paid their voluntary school fees will not be allowed to attend the formal? Is it departmental policy to punish students whose parents may not be able to afford the voluntary fees? If this is so, does that mean that the voluntary fees are not voluntary at all but are mandatory? If this school is not entitled to bring this pressure to bear about the formal, will the Minister, as a matter of urgency, intervene to allow all students to attend this function?

The Hon. MICHAEL EGAN: All honourable members would agree that attendance at end-of-year school functions, particularly end-of-year school formals, is a highlight of the lives of many students. To exclude students for the non-payment of school fees, which is something that is outside their control, would be most inappropriate. In the case of the Belmont High School year 10 formal, I can inform the honourable member that the school education director has made contact with the school's principal, and the director has confirmed that no students in year 10 will be excluded on the grounds of non-payment of school fees from the year 10 formal, which I understand will be held on 25 November. And that is as it should be.

[Interruption]

There are valid reasons for exclusion, but the non-payment of school fees is not a valid reason.

RURAL COMMUNITY OF THE YEAR AWARD

The Hon. CHRISTINE ROBERTSON: My question is addressed to the Minister for Rural Affairs. What is the Government doing to recognise excellence in country communities?
The Hon. TONY KELLY: Country communities are a vital part of the social and economic fabric of New South Wales. There is a wealth of talent and ideas in rural and regional communities, which this Government believes should be recognised. That is why I am pleased that the Government is the principal sponsor of the Rural Community of the Year award through the Department of Lands. These awards are an important part of our push to ensure that ideas and talent in country New South Wales are encouraged. In a ceremony held in Orange recently I was pleased to announce that the Tibooburra Village Committee was the winner of the 2004 New South Wales Community of the Year award.

The Hon. Duncan Gay: A good place! It's great being at the pub there, especially without Blackie.

The Hon. TONY KELLY: It is a good place. The purpose of the community of the year award is to acknowledge the terrific contribution communities are making to their own social, cultural and economic development. Tibooburra Village Committee was selected from five outstanding finalists to be named as the New South Wales Community of the Year. Other finalists for the major award—and these are all great places—were: the Delegate Progress Association, Milparinka Heritage and Tourism Association—

The Hon. Duncan Gay: That's near Tibooburra.

The Hon. TONY KELLY: So there were two communities in Peter Black's area. The other two were South Inverell Residents Association and Yeovil Multipurpose Health Centre. Yeovil, which is the greatest little town in the west, is about 20 miles from home.

The Hon. Michael Egan: How many people live there?

The Hon. TONY KELLY: About 300. Yeovil is a great place. When the Coalition Government was in power it tried to privatise the local hospital and all the local members of the National Party decided to resign en masse.

The Hon. Michael Gallacher: What—about two people?

The Hon. TONY KELLY: About 50 of them at the time, I think. The Coalition Government came up with a new proposal to turn the local hospital into a private hospital. That showed just how out of touch the National Party was with the people of Yeovil. So the Yeovil people threatened to resign from the National Party en masse. By the way, I think the Yeovil community will be voting in the by-election this weekend. The small but spirited community of Tibooburra thrives on the devoted volunteer work of its village committee. Represented by the great Country Labor member for Murray-Darling in the other place, the isolated north-western town is based in an unincorporated area of New South Wales and therefore does not have a local council.

The Hon. Michael Egan: There's no Liberal candidate.

The Hon. TONY KELLY: No Liberal candidate?

The Hon. Michael Egan: No.

The Hon. TONY KELLY: Then why are all the Liberals doorknocking in Wellington?

The PRESIDENT: Order! There is far too much noise. The Minister has the call.

The Hon. TONY KELLY: Volunteers of the Tibooburra Village Committee provide all the services in the town, including maintenance of the water treatment plant, rubbish removal, rubbish tip maintenance, public toilet cleaning, weeding, and playground and park maintenance, because the village does not have a local council. [Time expired.]

The Hon. CHRISTINE ROBERTSON: I ask a supplementary question. Will the Minister elucidate his answer?

The Hon. TONY KELLY: Last year the committee purchased the Tibooburra War Memorial Bush Children's Hostel with the aim of establishing a war memorial museum, including accommodation for groups and families. Surrounded by Sturt National Park, Tibooburra is proving popular among tourists, particularly four-wheel drive enthusiasts. The committee has funded a scenic lookout overlooking Tibooburra and the surrounding area. The Department of Lands Community of the Year winner will receive a $2,500 award saver account from the Commonwealth Bank with a perpetual community plaque. The awards program is the first of its type in Australia to encourage, acknowledge and reward the achievements of those living in remote and regional communities of New South Wales and the Australian Capital Territory. Tibooburra Village Committee identified challenging issues in its town and came up with innovative and imaginative community activities to address them. Congratulations to Tibooburra Village Committee on its magnificent work, and congratulations to the proud community of Tibooburra.

KARIONG JUVENILE JUSTICE CENTRE MANAGEMENT

The Hon. Dr PETER WONG: My question without notice is addressed to the Minister for Justice. Given that Mr Vern Dalton's report outlined concerns regarding staffing problems, deficient skill levels, lack of training and lack of morale, combined with a lack of case management, is the Department of Corrective Services' response not simply punishing the young people at Kariong, but rather fixing endemic problems with the management of young offenders in New South Wales? How will the Minister ensure the safety of the young people now at Kariong, and what specialist programs will the department initiate for these young offenders? Will the Minister give an assurance that these young people will not be dealt with more harshly by Corrective Services than the general prison population?

The Hon. JOHN HATZISTERGOS: I can certainly assure the honourable member on the last part of his question. The Department of Corrective Services manages more than 600 offenders in the age bracket of 16 years to 21 years, and it does so quite successfully with the young offenders program that operates out of John Morony Correctional Centre and the Oberon Correctional Centre. We also have an Aboriginal program that operates at Brewarrina. So we have some experience and knowledge of how to deal with young offenders. However, having said all of that, the Dalton report clearly states that the nature of the offenders in custody at Kariong is substantially different to that of offenders who were in custody 10 years ago.

The Hon. Charlie Lynn: The problem is not with their nature; it is the way it is being run.

The Hon. JOHN HATZISTERGOS: There are two problems: one is the centre, and the other is the way it is being administered. The administration is being dealt with by its transfer to the Department of Corrective Services with a program, the first part of which I have already indicated has come into force. But let us not underestimate the deficiencies of the centre. When the place was constructed under the previous Government, in the early 1990s, there were a number of features—

The Hon. Catherine Cusack: What are you doing at Kariong?

The Hon. JOHN HATZISTERGOS: The Hon. Catherine Cusack was the senior policy adviser to the then Government, and no doubt she had some input into the structure of the place. I have a photograph that depicts the then Minister overlooking the model for Kariong. The swimming pool and all the other features that the honourable member felt should be part of Kariong were included at that time. Kariong was constructed on the basis of the honourable member's advice. She advised that all these things should be included. Kariong was built on the side of a hill, which interferes with radio communications.

The centre was built with perimeter fencing that makes it difficult for security to properly monitor it because of its shape, and now the inmates are located on the upper levels of the building, no doubt so they can all have bay views. This is a three-storey complex that the Hon. Catherine Cusack advised the Minister at the time should be constructed. The reality is that 10 years later the taxpayer is still struggling to get value out of the salary paid to the Hon. Catherine Cusack for the advice that this facility be constructed. We have indicated that a new regime of management will be applied to Kariong. It will not be brutal, it will not be oppressive but it will be appropriate to the needs of those offenders and will provide an appropriate range of sanctions and rewards for those inmates.

The Hon. Duncan Gay: You are going to save the ones drowning in the swimming pool, are you? Is that how you are going to look after them?

The Hon. JOHN HATZISTERGOS: The swimming pool was the Hon. Catherine Cusack's idea. She put it in the model, no doubt.

The Hon. Patricia Forsythe: Point of order: The Minister is clearly misleading the House.
The PRESIDENT: Order! The member knows perfectly well that is not a point of order.

The Hon. JOHN HATZISTERGOS: A photograph of the model shows Virginia Chadwick, for whom the Hon. Catherine Cusack worked, peering over it. There is a swimming pool and a gymnasium—all those facilities that she has been criticising—that are no doubt the product of the advice she gave.

The Hon. John Ryan: There is a swimming pool in the model, is there?

The Hon. JOHN HATZISTERGOS: Yes, it is in the model. We can see it. The Coalition Government built it, and at the time your Minister said that never again would any young inmate under the control of the Department of Juvenile Justice need to be transferred to the prison system. All the calls that the Hon. Catherine Cusack has made in recent times that there ought to be a mass exodus of people out of Juvenile Justice is contrary to the sort of thing the Minister said at the time.

KARIONG JUVENILE JUSTICE CENTRE MANAGEMENT

The Hon. CATHERINE CUSACK: I direct my question to the Minister for Justice. In light of the answer the Minister just gave, will he advise the House what strategies his department has in place at Kariong to prevent self-harm and suicide?

The Hon. JOHN HATZISTERGOS: Obviously the honourable member has not read the Auditor-General's report today, which indicates that the Department of Corrective Services, particularly in the way it manages adult offenders, has had a very impressive record of declining incidents, particularly of suicide. When the Coalition Government was in office it was condemned by the Human Rights Commission, which suggested that it was running the prison system in defiance of the international conventions against torture. Also, it had something like 13 deaths in the space of about three months, which led to the classification of the Department of Corrective Services at the time as running "the killing fields". When the honourable member wants to talk about experience in running correctional facilities appropriately, she should reflect on that.

When she talks about self-harm she should also look at the advice she gave to the Minister at that time which led to the creation of this facility, which contained a number of other opportunities for self-harm. For example, the facility that the honourable member advised the Minister should be constructed at Kariong contained glass in the cell compartment. There were tiles. This is all a product of the advice the honourable member gave to the Minister and which led to the construction of the centre.

The Hon. John Ryan: Point of order: The Minister is flouting the standing orders in a number of ways. He is making imputations.

[Interruption]

The PRESIDENT: Order! Members wishing to chatter must leave the Chamber.

The Hon. John Ryan: It is amazing how life imitates art. The Minister is deliberately misleading the House. There is no way that ministerial officers give Ministers advice about specific architecture of buildings in the responsibility of their departments. I do not think the honourable member was there at the time.

The PRESIDENT: Order! I remind the Minister that imputations cannot be made about other members of the Chamber except by way of substantive motion.

The Hon. JOHN HATZISTERGOS: I can well understand why the Hon. Catherine Cusack would want to dissociate herself from as much of the design of this facility as possible. Let me outline some other incidents of self-harm that were created by the construction of this facility. The inmates were accommodated in a three-storey block. As I said, the inmates had the upper levels of that building which, the Ombudsman found, created opportunities for falls and flight. There were significant problems for emergency evacuations and complications for access by ambulance and emergency services. According to the Ombudsman, the detainees had facilities and bathrooms that used glass and ceramics—materials that can be broken and used not only for self-harm purposes but also as weapons. These are the facts. When the honourable member talks about suicide, she should remember the confinement rooms had outside areas which are now largely unusable because they had bars that provided hanging points. [Time expired.]

WORKCOVER BUSINESS ASSISTANCE UNIT

The Hon. KAYEE GRIFFIN: My question without notice is addressed to the Minister for Commerce. Will the Minister inform the House how the Government is assisting small and medium-sized businesses to understand their workers compensation, occupational health and safety and injury management obligations?

The Hon. JOHN DELLA BOSCA: WorkCover currently provides information, advice and assistance to business through a range of services, including its web site, the WorkCover assistance service and the small business assistance strategy. Members will be aware of the success of the Government's small business assistance strategy throughout 2003 and 2004. To date, the strategy has seen more than 150 one-on-one interviews between small business operators and WorkCover inspectors; a pilot program providing 54 small businesses with up to three hours of free health and safety advice; and the establishment of a small business specific link on WorkCover's web site to provide a central location for business to obtain information on their rights and obligations, as well as copies of WorkCover's publications. It has held more than 40 seminars in rural, regional and metropolitan centres across New South Wales to assist small businesses to understand how the risk assessment process can be introduced into their workplaces, and the way in which they can make their workplaces safer and more productive, and therefore more profitable.

Notwithstanding these activities, I am pleased to inform honourable members of the establishment of a new unit within WorkCover dedicated to assisting small and medium-sized businesses with occupational health and safety, workers compensation and injury management. The specialised unit will co-ordinate practical assistance and advice to small and medium-sized enterprises to help them make their workplaces safer. The unit will organise seminars, demonstrations and workshops around New South Wales covering workers compensation, injury management and occupational health and safety. The first workshops are already being planned for western Sydney and the Riverina, dealing with chemical management and issues associated with heavy machinery used by small business.

The new unit is a progression from WorkCover's small business assistance strategy. Many small- and medium-size businesses have limited resources, and we are responding by helping to ensure they meet their workplace safety, workers compensation and injury management responsibilities. The House will be aware that this is an area where private safety consultants sometimes take advantage of small- and medium-size businesses, giving the false impression that risk management is difficult or expensive. The new business unit will provide practical advice and assistance, with a team of trained staff taking an educational approach. The unit will also implement targeted initiatives to assist in the effective management of injuries where they do occur. Earlier this week WorkCover appointed an acting director of the unit. I have no doubt that the business assistance unit will be of immense benefit to small and medium-sized employers throughout the State. I look forward to informing the House about the unit's full work program for 2005.

GOULBURN HIGH RISK MANAGEMENT UNIT

The Hon. PETER BREEN: Is the Minister for Justice aware that the inquiry into Goulburn's High Risk Management Unit, which was revealed in the Ombudsman's annual report, is now almost completed? Is it a fact that a draft report has been forwarded to the Department of Corrective Services containing preliminary findings and recommendations? Will the department be reporting to the Minister on matters raised by the Ombudsman and will the Minister be making those matters public? Will the Minister assure the House that he is not running the High Risk Management Unit contrary to the provisions of the International Convention on Torture?

The Hon. JOHN HATZISTERGOS: I am not aware whether the preliminary report in relation to that issue has been received by the department but no doubt at some time it will be. If it has not already been received, when it is received it will be responded to in the appropriate way. As I understand it, publicity for reports is largely a matter for the Ombudsman to determine. In relation to the unit being run contrary to the provisions of the International Convention on Torture, the honourable member is probably confused about the way the department was running its business back in the days of the Coalition Government, when there was a finding made to that effect. From the one discussion that I have had with the Assistant Ombudsman in relation to this matter I have no reason to be concerned about the prospect of any breach of the nature that he has described.

SOUTH COAST RAIL SERVICES

The Hon. DON HARWIN: Is the Minister for Transport Services aware that a dozen elderly war veterans missed their opportunity to pay their respects to their fallen comrades at the annual Remembrance Day ceremony last Thursday at Bomaderry because a train that was due to arrive at 10.55 a.m. did not arrive until 11.20 a.m.? Has the Minister apologised to the outraged ex-servicemen? Given constant delays to trains between Kiama and Bomaderry, is the Minister deliberately running down the service as a precursor to closing the line south of Kiama?

The Hon. MICHAEL COSTA: I am certainly not aware of the specific instance mentioned but I have made a general apology to commuters for the problems we are experiencing on our rail system. However, as I have said constantly, commuters do not want apologies, they want solutions, and we are busily putting those solutions in place. I can advise that we are on track to have a draft timetable published by the end of the year. That will be the beginning of a process of rebuilding reliability into the rail system. I take great pride in the fact that we have implemented the safety measures necessary to ensure that we have a safe rail system following the Glenbrook and Waterfall accidents, which are critical incidents in the history of the rail system.

The Hon. Duncan Gay: You told us this morning that the evacuation procedures are still to be done.

The Hon. Michael Egan: Point of order: Every time a Minister replies to an Opposition question we get a constant barrage of interjections from the Leader of the Opposition and his deputy. Some of us in the House want to listen to the answers, but we cannot do that when this pair opposite babble away all through question time. I ask you to bring them to order.

The PRESIDENT: Order! I advise the Leader of the Opposition and the Deputy Leader of the Opposition that their voices are particularly loud and it is extremely difficult for members to hear the answers when they interject.

The Hon. MICHAEL COSTA: Loud voices and shrill voices aside, the answer I was giving is important. We have systematically gone through all the reports and inquiries commissioned by us and we have implemented a range of safety measures in which we take a lot of pride. They have been difficult for the work force to accept in particular cases, and that is understandable given some of the measures that were required. But we will not shirk our responsibility to ensure a safe rail system. In the course of implementing those safety measures, as I have repeatedly said—I am sure that the Leader of the Opposition has absorbed this, although I know it is difficult for him to absorb information at times—the safety requirements have led to a deterioration in on-time running. That has led to services that are unreliable, particularly in the afternoon peak.

The Hon. Duncan Gay: We have had safe trains that have run on time in the past.

The Hon. MICHAEL COSTA: I should not respond to the interjection from the honourable member as it is disorderly but it raises an interesting point: the timetable that the Coalition put in place in the early 1990s was determined to be structurally flawed by an independent inquiry. We are in the process of rectifying that structurally flawed timetable.

The Hon. Duncan Gay: Even Carl Scully—

The Hon. Michael Egan: Point of order: Madam President, I am trying to listen to the answer. This buffoon opposite keeps interjecting and prevents me listening to a very sensible answer from the Minister for Transport Services. I suggest that you bring him to order. And if he does not come to order, you should throw him out.

The PRESIDENT: Order! I remind the Deputy Leader of the Opposition that interjections are disorderly at all times.

The Hon. MICHAEL COSTA: We are in the process of a major rewrite of the timetable to ensure that it is safe. We want a safe, reliable system. This timetable is critical to that outcome. I apologise to those who have been inconvenienced. I certainly apologise to the people referred to in the question. I will be working as diligently as possible to ensure that we have a new timetable.

INDIA TRADE MISSION

The Hon. AMANDA FAZIO: Will the Treasurer, and Minister for State Development tell the House about the success of the Premier's trade mission to India?

The Hon. MICHAEL EGAN: Those who were listening last week—and there were not many on the Opposition benches—would have heard me report to the House on the Snowy Mountains Engineering Corporation working on a massive $100 million hydropower project in India. I can report today also that an Indian company, Infosys, is planning to invest in New South Wales. Infosys plans to invest in the Smart Internet Technology Research Centre, at the Australian Technology Park, in Redfern. This is the first major outlay by an Indian information technology company in an Australian research organisation. The agreement is a great model of co-operation between the Indian software industry and Australian research. The impact of the work by Infosys and the Smart Internet Technology Research Centre will be felt in banking, commerce, health and the entertainment industry. There is more good news from the Premier's trade mission. TAFE Global, the international arm of TAFE NSW, will train staff from Tata Consultancy Services, a part of the Tata group. I think most people worldwide are aware of it; it is such an important part of the Indian economy and is India's largest private company.

The University of New South Wales and the Jawaharlal Nehru University will exchange staff and students as part of a new fellowship program. The University of Sydney will also offer visiting research fellowships to academic research staff from across India. Tourism NSW has commenced a marketing campaign including trade development links in Mumbai and Delhi. There will also be a visiting journalist program and trade shows and missions. In addition, the huge Indian information technology corporation, Wipro, is looking at opportunities to expand into New South Wales at the Wollongong Innovation Campus. I congratulate the organisers of the trade mission and the Premier and I look forward to hearing about other business successes arising from it.

The Hon. Duncan Gay: Did they give you a map of Wollongong?

The Hon. MICHAEL EGAN: Wollongong? I will have you know I spend a lot of time in Wollongong. In fact, only earlier this year I addressed one of the graduation ceremonies at Wollongong University. I even occasionally take a holiday in Wollongong. I am a great fan of Wollongong City Beach. I am a great patron of the fish market in Wollongong.

The Hon. John Della Bosca: I almost drowned at Wollongong.

The Hon. MICHAEL EGAN: That is probably a reflection of your stupidity rather than the safety of the beach, because it is a very safe beach.

The Hon. John Della Bosca: It was Wonona Beach.

The Hon. MICHAEL EGAN: I prefer to go to Wollongong City Beach. The Wollongong district has some of the greatest ocean rock pools one will find in Australia.

The Hon. Dr Arthur Chesterfield-Evans: Point of order: Is the Wollongong beach relevant to the Indian trade mission?

The Hon. MICHAEL EGAN: To the point of order: It probably is because the natural features of Wollongong and the Illawarra are one of the reasons for its success. I am pleased to be able to sing its praises. It is a great place. It is well represented in the Parliament of New South Wales and in the Federal Parliament subsequent to the last election, because that dopey Green was thrown out on his ear!

The PRESIDENT: Order! The Minister will resume his seat. The Minister is not being relevant to the question asked.

FLEMINGTON MARKET SITE SALE

The Hon. Dr ARTHUR CHESTERFIELD-EVANS: With some trepidation, I direct my question to the Treasurer. Was the 39.63-hectare Flemington Market site valued by the Valuer-General on 31 March 1992 at $201.5 million? Is the Treasurer aware of how land prices have soared since that time? Did the Treasurer take all necessary steps to ensure that the land was sold at its true value? Why has the Government committed $1.5 million to maximise the value of the land after it was sold to a private company? Why in 2002 did the Government accept only $83 million for the land, including the recently refurbished multistorey market plaza, parking stations, government buildings and commercial and residential properties? Was there an offer to purchase the site for hundreds of millions of dollars above the final sale price?

The Hon. MICHAEL EGAN: I am glad the honourable member said he asked the question with some trepidation. I am pleased that I induce that state in him. However, he must be kidding if he thinks I have all those details in my head. I will certainly have a look at the question and see whether I can provide an answer.

BROKEN HILL AUSTRALIAN INLAND EMPLOYEES

The Hon. RICK COLLESS: I direct my question to the Minister for Rural Affairs, and Minister for Local Government, representing the Minister for Energy and Utilities. Following the merger of Australian Inland with the State's largest energy retailer, Country Energy, can the Minister confirm that the people previously employed by Australian Inland in Broken Hill will retain their jobs in Broken Hill and not be sent elsewhere? Will there be any local input from Broken Hill on the Country Energy board?

The Hon. TONY KELLY: That question is not really relevant—

The Hon. Michael Egan: Order, Madam President. What dopes some Opposition members are! They do not even know which Ministers are responsible for what.

The Hon. Duncan Gay: Are you still gibbering or what?

The Hon. Michael Egan: This has nothing to do with Country Energy.

The PRESIDENT: Order! Is that the Leader's answer to the question?

The Hon. Michael Egan: Madam President, he does not know to whom the question should be addressed. He should do his homework and ask the question again.

The Hon. Rick Colless: To the point of order: The question was directed to the Minister for Rural Affairs, and Minister for Local Government in his capacity as having an impact on rural affairs interests in Broken Hill.

The PRESIDENT: Order! The Leader of the Government can answer any question, and he has obviously undertaken to do so.

The Hon. Duncan Gay: To the point of order: I clearly understood the Leader of the Government to rise on a point of order rather than to give an answer.

The PRESIDENT: Order! My understanding is that that was the answer. Minister, was your response a point of order or an answer?

The Hon. Michael Egan: To the point of order: The question was out of order, therefore I cannot answer it.

The Hon. Duncan Gay: It was not directed to you.

The Hon. Michael Egan: Further to the point of order: Questions must be asked of the Minister who—

The Hon. Michael Gallacher: You are all a mess. You are hopeless. It was directed to the Hon. Tony Kelly.

The Hon. Michael Egan: Board representation is determined by shareholders.

The Hon. Michael Gallacher: You need an answer committee! You have had your face smacked; you are wrong again.

The Hon. Michael Egan: The standing orders provide that a question must be directed to the Minister who has portfolio responsibility for matters referred to in the question. As Leader of the Government in this House I can take it upon myself to answer any question.

The Hon. Rick Colless: Well answer it!

The Hon. Michael Egan: However, I will not encourage honourable members to behave in a sloppy, ill-prepared way. If they muck up their questions, they have to wait until tomorrow.

The Hon. Duncan Gay: Further to the point of order: It was a question about energy and it clearly should be referred to the Hon. Tony Kelly, who in this Chamber represents the Hon. Frank Sartor, who is the Minister for Energy and Utilities. In a previous Parliament I was the shadow Minister responsible for energy and I tried to ask the Treasurer and the Assistant Treasurer questions about this topic in their capacity as shareholders but they refused to answer them. All this buffoon is doing is wasting the time of the Parliament.

The PRESIDENT: Order! I remind honourable members that they can ask questions of Ministers only about public affairs with which the Minister to whom the question is directed is officially connected, or regarding any matter of administration for which the Minister is responsible. It is incumbent upon members to ensure that the Minister to whom they direct their question is the correct Minister.

The Hon. Rick Colless: I did, so it is in order.

The PRESIDENT: I cannot recall the question at this stage.

The Hon. John Ryan: To the point of order: The question was asked of the Hon. Tony Kelly, and the Leader of the House rose on a point of order. Madam President, I imagine that you would rule that the point of order is not upheld and that the Hon. Tony Kelly is capable of answering the question in his capacity as representative of the relevant Minister.

The Hon. Michael Egan: Further to the point of order: Let me remind the House of the question. It was directed to the Minister for Rural Affairs, and Minister for Local Government, representing the Minister for Energy and Utilities and it states:

Following the merger of Australian Inland with the State's largest energy retailer, Country Energy, can the Minister confirm that the people previously employed by Australian Inland in Broken Hill will retain their jobs in Broken Hill and not be sent elsewhere? Will there be any local input from Broken Hill on the Country Energy board?

They are all matters for portfolio Ministers. The question was asked of the Hon. Tony Kelly representing the Hon. Frank Sartor, who is not responsible for those matters. If the honourable member does not want to ask the question, I will get a member on this side of the House to ask it of me so that it is in order and so that I can provide a response. However, I will not encourage members opposite to be ignorant of the standing orders of this House.

The Hon. Duncan Gay: Further to the point of order: Madam President, I request you to rule in order a question that was clearly in order.

The PRESIDENT: Order! I revert to my original ruling. If the Leader of the Government wishes to answer the question, he can do so either in his capacity as Leader of the Government or in his capacity as the Minister of whom the question should have been asked. The Minister has the call.

The Hon. Michael Egan: I would love to answer the question, but I will do so only when it is asked correctly.

The Hon. Duncan Gay: Further to the point of order: Madam President, come on! That question has to go to the Hon. Tony Kelly. We have to have some rules in this place.

The PRESIDENT: Order! The member will address the point of order in the correct fashion or he will sit down.

The Hon. Duncan Gay: Madam President, we took a point of order that the question was asked correctly. The Treasurer took a point of order; he did not give an answer. If you rule against us, we will move dissent from your ruling.

The PRESIDENT: Order! I have ruled that the Leader of the Government can answer the question either in his capacity as Leader of the Government or as the appropriate Minister.

The Hon. Duncan Gay: He did not answer; he raised a point of order.

The PRESIDENT: Order! The Minister made a response and that is the answer. A Minister can answer a question in any way he or she sees fit as long as the answer is relevant—and it was a relevant answer.

The Hon. Duncan Gay: Point of clarification: The Minister did not answer. The Minister took a point of order. Madam President, could we request once again that you adhere to your position properly and rule that the question was in order and that there was no answer from the Treasurer; he moved a point of order.
The Hon. Michael Egan: The question should have been directed to me in the first place, not to the Hon. Tony Kelly. This is an example of the Opposition trying to play games in this place. The Opposition knows who is responsible for the shareholder responsibilities of the State-owned corporations. It deliberately tried to ask the question of a Minister representing another Minister who is not responsible for the matter raised. It was a deliberate tactic by a mischievous and ignorant Opposition.

The PRESIDENT: Order! The Minister has answered the question.

BROKEN HILL AUSTRALIAN INLAND EMPLOYEES

The Hon. IAN WEST: My question is directed to the Treasurer. Following the merger of Australian Inland with the State's largest energy retailer, Country Energy, could the Treasurer confirm that the people previously employed by Australian Inland in Broken Hill will retain their jobs in Broken Hill and not be sent elsewhere? Will there be any local input from Broken Hill on the Country Energy board?

The Hon. MICHAEL EGAN: A very good question, and it was directed to the right Minister!

The Hon. John Ryan: Point of order: The member asked the question without using the right paper from which to ask it. It does not have my picture on the back of it.

The PRESIDENT: Order! There is no point of order.

The Hon. MICHAEL EGAN: I can advise the House that those people previously employed by Australian Inland Energy Water Infrastructure [Australian Inland] will continue to be employed in Broken Hill by Country Energy. I can also advise the House that the amalgamation of Australian Inland with Country Energy has been exceptionally well received in Broken Hill. The chief executive officer of Country Energy has spent quite a time in Broken Hill, and I know that the people of Broken Hill support the decision that the Government has made.

CLIMATE CHANGE

Mr IAN COHEN: I ask the Minister for Transport Services, and Minister for the Hunter a question without notice. As the Minister is on the record as saying that he is a " greenhouse sceptic", will he now change his opinion, given the evidence of climate change presented in a report by the CSIRO and the Bureau of Meteorology to the International Climate Change Task Force in Sydney yesterday, and the comments of the Premier that, "This study is a warning that there may be more dramatic climatic extremes ahead unless we act"?

The Hon. Michael Egan: Point of order.

The Hon. Michael Gallacher: You're on a roll!

The Hon. Michael Egan: Absolutely. The question is out of order for a number of reasons: first, because it is directed to the wrong Minister, and, second, because Mr Ian Cohen knows full well that members cannot ask for opinions in their questions.

The PRESIDENT: Order! I remind the member that opinions may not be asked for in a question. The member's time for asking his question has expired. He can rephrase his question and ask it when he is next given the call.

GOVERNMENT AGENCIES FUEL COSTS SUPPLEMENTATION

The Hon. PATRICIA FORSYTHE: My question without notice is addressed to the Treasurer, and Minister for State Development. In view of the world price of fuel, what is the underlying assumption of fuel prices in the current budget? Have arrangements been made to ensure that departments that have high transport costs, such as the essential services of police, ambulance and fire brigade, do not have to make service cuts because of fuel costs? Is supplementation available to these departments if fuel costs remain high?

The Hon. MICHAEL EGAN: Supplementation is always available in the right circumstances.

OVINE JOHNE'S DISEASE

The Hon. TONY CATANZARITI: My question is addressed to the Minister for Primary Industries. Could the Minister update the House on the progress of the State's ovine Johne's disease [OJD] management program?

The Hon. IAN MACDONALD: The management of ovine Johne's disease in New South Wales has undergone a complete and very positive change of direction in recent years. Members would recall the deep divisions caused by OJD management in the past. Fortunately, the State Government is committed to tackling the problem head on, based on solid industry input and direction. We now have the foundations for a much more equitable and practical system of disease management, and this will help the sheep industry in New South Wales, and other important industries, move forward into the twenty-first century. I acknowledge the work that the Hon. Richard Bull has done in this regard. Today I have taken the next step in building on the future. I have announced today that a former National Party Minister, Garry West, will be the chair of the new OJD Industry Advisory Committee.

[Interruption]

I acknowledge that when it comes to sheep The Nationals know everything it is possible to know. I would rely on The Nationals to know all there is to know about sheep—front to back. Mr West was a Minister in both the Greiner and Fahey governments and was the member for Orange for more than 20 years. He served as a Minister in a range of portfolios, including Lands and Forests, Conservation and Land Management, and Local Government and Co-operatives. I am sure members will join with me in congratulating Mr West on his upcoming new role. I am sure also that all will agree he will be a most competent chair of that committee.

I am disappointed that the Deputy Leader of the Opposition is not present to hear this announcement; I am sure he would have appreciated my comments in this regard. The Nationals often criticise the Government for supposedly being out of touch with the bush. This initiative shows just how prepared we are to draw on the very best expertise and advice, wherever we can find it. And in relation to sheep, that advice is best obtained from The Nationals. The OJD Industry Advisory Committee will be the key body advising the Government on the ongoing OJD management program in New South Wales.

[Interruption]

It is quite clear that the Hon. Don Harwin knows nothing about sheep. Committee members will liaise closely with producers to ensure they have detailed input into the direction their industry takes in the future. I am sure Ned Flanders, if he is provoked, will be able to say something about sheep. The committee will particularly oversee the rollout of a fairer and more simple system of funding disease control into the future. This new system is embodied in the Agricultural Livestock (Disease Control Funding) Amendment Act 2004, which passed Parliament in June this year. Even the staff of the Opposition are amused at this. The Hon. Charlie Lynne is cracking up behind his computer. I do not know what he is reading, but I would wager is not a report on the poor Swans footballers he took to the Kokoda Trail. They fell off cliffs and, since their return, have been coming down with all sorts of diseases. The only decent thing about all that is they have kept Melbourne and Collingwood in the premiership next year.

The legislation was specifically designed to ensure that only those producers who were contributing to the disease program could benefit from its support. In short, it is a fairer, more consistent way of managing this divisive disease. Under the guidance of the new OJD advisory committee team we will move forward with this more equitable system of funding disease control in New South Wales. Once again, I thank our 25,000 sheep producers for working so constructively on this new, united direction for their industry.

The continuing progress on OJD management shows what can be achieved when industry and the Government sit down at the same table to talk through difficult issues. The voices of producers are now being heard loud and clear throughout this process. I look forward to working with Mr West on this very important issue.

METROPOLITAN STRATEGY

Ms SYLVIA HALE: I address my question to the Minister for Local Government. Given that councils have started to protest against not being sufficiently included in the metropolitan strategy and the planning reform process currently under way, and that new development corporations that override the planning powers of councils are being imposed across Sydney, is it the intention of the Government to sideline local government from planning, or is the planning reform process in total disarray, with the Department of Infrastructure, Planning and Natural Resources, the Premier and Frank Sartor not talking to the Minister and the Department of Local Government about these issues?

The Hon. TONY KELLY: Again, all the content of that question relates to planning issues and should be directed to the Minister for Infrastructure and Planning.

SMALL BUSINESS AWARDS

The Hon. EDDIE OBEID: My question is directed to the Treasurer. Will he inform the House about recent wins by New South Wales small businesses?

The Hon. MICHAEL EGAN: I am pleased to inform the House that two Government-assisted companies were recently recognised at the 2004 Australia Post New South Wales-Australian Capital Territory Small Business of the Year awards. On 16 October an Armidale-based veterinary health company, Veterinary Health Research Pty Ltd, was crowned the 2004 Australia Post New South Wales-Australian Capital Territory Small Business of the Year. The company was recognised for developing the world's first all-inclusive system for accurately identifying resistant sheep parasites. I am pleased to say that the Government has assisted Veterinary Health Research, through the High Growth Business Program of the Department of State and Regional Development.

The company's patented drench test kit allows graziers to test across six categories of roundworm drench groups to identify which are ineffective in their flocks. The system helps prevent graziers wasting dollars on ineffective drenches. At the same time it lifts production, as the health of sheep flocks is improved, resulting in better wool yields, better lambing percentages, and better nutrition as food is not wasted fighting an immune response. The colour-coded system simplifies the collection of samples, which are then analysed in a laboratory.

The Minister for Primary Industries should listen to this. The wool industry says that roundworm currently costs about $250 million a year due to costs associated with treatment chemicals, labour, production losses, and higher sheep mortality rates. That figure is tipped to blow out to about $700 million a year over the next decade due to growing resistance. The work of Veterinary Health Research will help address this problem.

Another New South Wales Government-assisted company recognised at the awards was Balmain-based Concept Express, which was honoured for solving an age-old tradesmen's dilemma with a simple but effective solution. Concept Express's Ozzy Nozzy invention helps stop the problem of run-on in glue and silicon guns, which not only is wasteful but can compromise the finish of a job. The Ozzy Nozzy replaces the standard nozzles used with cartridge dispenser systems. The invention works by using fluid-flow principles and slurry-related dynamics to prevent flow-on occurring. The company has been assisted in its marketing and patenting by the Department of State and Regional Development—as a member, of course, of the Australian Technology Showcase [ATS]. I congratulate these two ATS companies on their recent wins and wish them all the best for the future.

If honourable members have further questions, I suggest they place them on notice.

Questions without notice concluded.

DUTIES AMENDMENT (LAND RICH) BILL

SMOKE-FREE ENVIRONMENT AMENDMENT BILL

SHOPS AND INDUSTRIES AMENDMENT (SPECIAL SHOP CLOSURES) BILL

Bills received.

Leave granted for procedural matters to be dealt with on one motion without formality.

Motion by the Hon. Tony Kelly agreed to:

That these bills be read a first time and printed, standing orders be suspended on contingent notice for remaining stages, and the second readings of the bills be set down as orders of the day for a later hour of the sitting.

Bills read a first time and ordered to be printed.

[The President left the chair at 1.03 p.m. The House resumed at 2.30 p.m.]

TABLING OF PAPERS

The Hon. John Della Bosca table the following papers:

FSS Trustee Corporation
SAS Trustee Corporation

Ordered to be printed.

HEALTH LEGISLATION AMENDMENT (COMPLAINTS) BILL

HEALTH REGISTRATION LEGISLATION AMENDMENT BILL

NURSES AND MIDWIVES AMENDMENT (PERFORMANCE ASSESSMENT) BILL

Second Reading

Debate resumed from an earlier hour.

The Hon. Dr ARTHUR CHESTERFIELD-EVANS [2.32 p.m.]: It should be acknowledged that the health system cannot be fixed by legislation. If John Laws thinks somebody ought to spend longer in gaol, or if a committee finds that the health system does not work very well, the Government comes up with a flurry of legislation so it can be seen to be doing something. We saw it with the registered clubs legislation, which was introduced after someone did something the Government did not think was right. I am surprised we do not have legislation before us to make sure the trains run on time.

The health system is complicated and needs to be fixed in a systematic fashion. If one looks at a systems analysis, the health system is the victim of the division of responsibility between Federal and State governments and their attempts to behave like corporations and try to shift costs. The classic corporate method is to privatise the profits and socialise the losses. This Government is trying to act like a corporation and shift the costs elsewhere while keeping the money. This is particularly unsatisfactory when it distorts the major components of health policy. John Menadue, former head of the Prime Minister and Cabinet Department, and a distinguished Chief Executive of Qantas, said the problem with the health system is that nobody is in charge and nobody takes responsibility for it. That is right. Lest I be accused of humbug, I have devised a 10-point plan to fix the health system. The first thing to do is prevent health problems. In that way people will not need to go to hospital.

Reverend the Hon. Dr Gordon Moyes: Have you proposed this before?

The Hon. Dr ARTHUR CHESTERFIELD-EVANS: Yes, I have, but it needs to be done again; it has not made any difference. Prevention saves a lot of money, yet the Government does not even have a decent tobacco policy. It is introducing a tobacco policy that should have introduced 20 years ago, to take effect in 2007. With 12 deaths a day caused by tobacco, the Government is waiting until 2007 to try to change the norm in clubs. That demonstrates how slack it is. It is spending less than $2 million on Quit programs when it should be spending more than $50 million, according to the best world evidence. This Government is not promoting prevention, nor is prevention being promoted at the Federal level.

The second point in the plan is to get a single source of funding. Basically, the Federal and State governments must work together to get a single source of funding so that the major driver of health policy is not cost shifting between Federal and State or to the private sector. We need to fund one system. Those who want to go outside that system can pay. The Howard Government's policy of subsidising private health insurance is extremely foolish, because it is an uncapped system. Also, the shifting of costs between the hospital system and the non-hospital system—which, of course, is Medicare, private funds and individuals paying for their own health system—is bad. Figures on hospital admissions are distorted by whether patients are private or public patients, because the Government is trying to get money from other sources.

My third point is that to get a better deal we need to use competition carefully, but we must not assume that the market will deliver a good system. The market will deliver the most money to the people who provide the service. It might be quite good at procedural efficiency but it is extremely bad at allocative efficiency if there is no serious mechanism for allocative efficiency. In other words, one might be doing the wrong thing very efficiently but it is still the wrong thing. We need a bureaucracy—perish the word—to assess what needs to be done and set the priorities, and to use the market only within those priorities.

The fourth point is that we must integrate the community support system with the acute system. That is difficult because the community system is supported in part by local government, in part by the Federal Government and in part by the State Government. The acute hospital system is supported broadly by the State Government, although it is increasingly being supported by the private hospital system. As I say, there should be one system, and community support should be integrated into that system. If people can be looked after at home, hospital admission costs will be reduced, and that will reduce the strain on the emergency system, which is the part of the system that is cracking most conspicuously.

The fifth point in my plan is the need for public discussion of the limits of intensive care. The Government, under the previous Minister for Health, Craig Knowles, included in advisory committees people who might have been his enemies. Effectively, he has entrenched a lot of vested interests. Intensive care is a very sensitive issue, but intensive care beds are often used by people who need considerable nursing resources, at great cost, when their long-term prognosis for quality years of life is poor. It is a total misuse of resources. We need to talk openly about the policies of admission to intensive care.

My sixth point is that pharmaceuticals are an increasing percentage of the Health budget. We must make more intelligent use of investigation of pharmaceuticals. To do that we need a research project to show which drugs are the most cost-effective. The assessment process, which currently is performed by the Pharmaceutical Benefits Advisory Committee, should compare not just pharmaceuticals to other pharmaceuticals but pharmaceuticals to non-drug modalities. Drugs used for smoking cessation are very expensive. In total, $160 million was spent on those drugs. Compared against doctors just advising patients to quit, they doubled the success rate but, dollar for dollar, if that much money was put into a television Quit campaign there would be far more success and many more health benefits.

I believe that pharmaceuticals are being misused. Some of the drugs used to increase bone density—the evidence for them is somewhat dubious—are not as effective as quitting smoking, undertaking exercise programs and having good nutrition would be in the elderly. But there is no research comparing the two methods because research now is being jointly funded, for short-term gains, with drug companies to a large extent, and after the Wills report again that is quite unwise. Doctors should be mindful of what pharmaceuticals they are prescribing. In a very worrying article in today's Daily Telegraph Dr Johdi Menon refers to a very smart computer program that will collect information from doctors about the drugs they use. The doctors can then make money by selling that information to drug companies.

But once again the pharmaceutical companies will be much better able to target doctors to get them to use their products. The marketers will become even more important than the scientists in the choice of drug that is used. That is a bad thing. The cost of pharmaceuticals as a percentage of the total cost of the health system is climbing. It would be a brave man who said that this spending is cost-effective. Overuse of diagnostic systems is favoured by the market system, where everything is profit driven. As with pharmaceuticals, that must be subject to cost-benefit analysis.

My seventh point relates to reform of medical indemnity, replacing tort law with a safety management system. That refers to the Health Care Complaints Commission, which I will come to later. The adversarial system of medical indemnity is expensive. It is forcing doctors out of practice. It delivers a culture of fear and cover-up rather than a willingness to look at the system, and that is very worrying. My eighth point relates to paying a reasonable Medicare rebate and moving towards a salaried medical service. If doctors want to be millionaires they should not do it on the back of sick people. Basically, there are plenty of people who are interested in being doctors on a reasonable salary, and doing a job for humanity. They would be willing to work for reasonable salaries or even a reasonable fee for service. Medicare has been run down against the consumer price index for about 30 years, which is why doctors are abandoning it. They are criticised for being greedy, which is ridiculous from a government that for many years has effectively starved them of a reasonable return for their work.

My ninth point relates to setting up community medical centres, including salaried paramedical personnel, so that doctors are not doing things such as marriage counselling—things that they are unsuited for and do not have time for. Some of the work that general practitioners do could be done by others, making better use of medical resources. My tenth point relates to the establishment of a national dental scheme. Of course, the vested interests are dead against this. I could give many reasons for this being the case. Those are my proposals for the health system.
These bills do not do much in this regard. They try to lay some of the failures of the health care system at the foot of the Health Care Complaints Commission [HCCC]. The commission was set up on a model that, to a large extent, assumes that problems were caused by poor communication or by a few bad apples who had to be chased along. This is a fairly primitive model of mistakes in industry. Most failures are system failures in which a number of miscommunications, misunderstandings or gaps in the system lead to adverse outcomes. A series of relatively minor problems that are not identified lead to a bad outcome. If this happens continually it may reset the bar as people then expect relatively poor outcomes.

When I moved from Australia to Britain in 1979 I found that the standard at Royal Prince Alfred Hospital was far higher than the standard at hospitals I went to in Britain. Doctors said, "Oh well, they are old. You would not do that sort of treatment in someone this old." There was a lowering of expectations, a more philosophic approach to dying. That is fine, but not if, with a little more effort and intelligence, people could be saved. This lowering of expectations can happen by stealth. I note that the legislation refers to root cause analysis. But what are the limits of the root cause analysis? The systemic problems in the health department between the Federal, State and private systems have their root cause in the misapplication of resources.

There may be difficulties in communication between the emergency department, the ward and the intensive care unit. There may be difficulties in communication between shifts. There may be difficulties in communication because of a lack of Australian-trained staff and because of people with poor language skills. It may be difficult to find qualified doctors to fill many jobs. The rundown in the hospital system means that certain hospitals have staffing difficulties, and I do not just mean remote hospitals. I visited John Hunter Hospital in Newcastle, which is the second-biggest city in New South Wales. John Hunter is probably the newest hospital in the State. It is huge, it is complete, it has a medical school, and it has all the bells and whistles. Yet it could not staff the emergency department without declaring it an area of need and advertising worldwide.

Stating that there are only a few little old hospitals that are having problems and that it is not a systemic problem might be convenient for the Government, but it does not relate to reality. Night shifts in country hospitals are far less pleasant than having even the smallest general practice, where at least staff work in daylight hours. Staffing difficulties mean that existing staff have to be spread more thinly, and the likelihood of having a mishap in the back ward is extremely high. The problem will not be fixed by the legislation. The Walker report did not come to terms with the question of whether an adversarial system or a supportive system is needed in health. The fact that a lawyer was put in charge of the HCCC sends a message that it is going to have a prosecutory function, which is quite worrying.

Amanda Adrian was very much made a scapegoat for the failure of the HCCC. As I said, I think that the commission's model was one of finding a few bad apples and improving communication with the bulk of the people. I am not sure that having a centralised body improves communication. To improve communication between doctors and patients perhaps there should be a patient advocate in every significant hospital. Seminars for the doctors and patient advocates may show that they are not communicating well. Patient feedback may show which doctors are communicating well and which doctors are not. Information from patients could be discussed at meetings so that doctors know how well they are communicating. That imposes pressure to change the norm in terms of the need for doctors to communicate with patients. It does not cost very much either.

Under the leadership of Amanda Adrian, the Health Care Complaints Commission tried to establish a more systemic model that was more in keeping with the risk management theory taught in most industries to deal with industrial accidents. It was developed in the aviation and oil industries, in which a number of small mistakes can lead to tragedies. If those mistakes are corrected early enough, tragedies can be avoided. Those mistakes relate to maintenance problems and external and human factors. Because of the belief that the problem was a few bad apples and a communication breakdown, Amanda Adrian was not provided with the appropriate resources to examine the entire health sector. She tried to get the resources to do that, but she was very slow because huge amounts of material came to light from the whistleblower nurses and elsewhere.

More than 100 cases were brought to her attention, of which 70 were found to be worthy of investigation. The inability to get the necessary personnel and resources together quickly caused delays, which made her report look bad, and there were suggestions that she was covering up. Her unwillingness to blame individuals also caused her demise. It is interesting that throughout this process no blame was sheeted home to administrators. If administrators limit the staffing decisions that can be made by departmental heads it can result in staff skills being stretched to breaking point and inadequate backup. Those decisions made by administrators are not capable of being criticised. We must also question how far the root cause analysis is allowed to go.
Can it examine the faults between the Federal and State governments, the allocation decisions made in area health services, within NSW Health and within hospitals, and the skill levels of the junior staff? They may be stretched to the limit of their knowledge or capacity to care for the number of patients requiring attention. If two patients are very sick at the same time that can cause unreasonable pressure to be placed on staff. Simply changing the HCCC to a more adversarial model will not help. Perhaps we should go for a systems analysis model. I know the Clinical Excellence Commission tries to get doctors to look at their practice patterns systematically. If they try to do that in a framework in which anything may be used against them it will be very difficult.

The Utah model is interesting. Under that model, if doctors report to the administration within 48 hours of their becoming aware of a significant event in which they played a part and in which their performance might not have been optimal, they are defended by the hospital system. At the moment our hospital system defends itself and doctors to some extent, but it has a discretion. Therefore, doctors must carry their own insurance in case the hospital does not believe someone else was at fault. In Utah, provided the doctors confess within the time frame, the system will defend them, no matter how incompetent they might have been. That leads to a huge number of problems being identified and prevented. Analysis of the system is much more effective. It was found that more than 50 per cent of the errors related to medication, but not to incorrect prescriptions. In other words, a weak or small person who was given a standard dose was often overdosed because his or her body could not cope. A large number of the other errors related to the system. The percentage of clinical mistakes was very small; in fact, they represented less than 10 per cent of the total.

Given that situation and the chance of miscommunication being extremely significant, I am not sure that an adversarial model is what is needed. Perhaps the HCCC should simply define what happened and facilitate communication. Once it has discovered what went wrong, the Medical Board or some external body could then pursue the prosecution. The Medical Board could then look at the medical revision system, which I have said for some time is mickey mouse in New South Wales. However, Professor Brian McCaughan from the Medical Board assures me that it is better than it was and that he is working on it. The Health Legislation Amendment (Complaints) Bill is designed to blame the HCCC.

The one bright note in the window-dressing of this legislation is the amendment to section 98 of the Health Care Complaints Act. This amendment will provide protection from liability for complainants who make a complaint in good faith. Hopefully, the whistleblower nurses can take some heart from that. However, given what happened to them, it is hard to believe that anyone else will follow that path. I believe that none of them is now working in the health system and none is likely to be in the future. That in itself is a very strong and worrying message.

The Hon. Duncan Gay: Every day I get people ringing up and complaining but not willing to say anything publicly because they have been threatened.

The Hon. Dr ARTHUR CHESTERFIELD-EVANS: I have had the same experience. One caller who telephones me regularly with information will not give me his name. I call him "Anonymous One", and when he calls that is how he identifies himself. He is in one of the health systems. The point is that whistleblowers have had a very hard time in this State, and that situation is not likely to improve. Of course, whistleblowers and many of the inquiries that this House conducts would not be necessary if there were a more open culture within this Government.

In general, this legislation has some good components. The ability to examine the conciliation process and complaints resolution is a step in the right direction. The separation of a team to undertake the root cause analysis may be helpful. It is all very well for bureaucrats to examine issues, but if the Government provided the appropriate resources to the people doing the job many of the problems would be solved. A root cause analysis model is all very well, but for every person analysing there is one less person doing the job. A person high up in the mental health system has told me that 50 per cent of his time is spent managing issues and communicating upwards about things that might happen. The more time he spends analysing and passing information about errors up the line—covering his bosses politically—the less time he spends preventing the errors occurring in the first place.

There is some danger too in analysing things to death in terms of resource allocation. I have asked the Minister for Health to determine how many people are involved in the front line; it is important not to have doctors driving everything, lest all attention is given to intensive care rather than prevention because that is more interesting and exciting and, of course, more politically sensitive. So we need to know exactly what people are doing. That is a key allocation decision, and not one that should be made by the market. Sometimes I think such decisions should not be made by doctors either because doctors are very patient-focused and concentrate on the needs of their patients at the moment and fight for those needs. The fact that with better prevention their patients would not be in hospital at all is a consideration that, I am afraid, does slip off the radar sometimes.

In essence these bills are tinkering. Some of them are the result of the inquiry conducted by Bret Walker, SC, who was very focused on what legislative changes should be recommended. I suppose that as a barrister of some experience who may one day become a judge he concentrated on what the law should be. Of course, he is very familiar with the adversarial model, although in his seminars he indicated that he still did not completely believe that that was the best way to manage risk. I am not sure that the changes to the HCCC reflected that degree of enlightenment. These bills are neither particularly bad nor particularly good; they are minor tinkerings. They make some progress, but I do not think that this is the way to fix the health system—and I do not think we should pretend that it is.

The Hon. PATRICIA FORSYTHE [3.01 p.m.]: The Health Legislation Amendment (Complaints) Bill and its cognate bills, the Health Registration Legislation Amendment Bill and the Nurses and Midwives Amendments (Performance Assessment) Bill, represent yet another chapter in what could be described as the Camden and Campbelltown saga. One hopes, though, that these bills will draw that long and sorry saga to a conclusion. The bills are the result of the review conducted by Bret Walker, SC, into the Health Care Complaints Commission [HCCC], which arose out of concerns that insufficient action had been taken to properly examine the complaints that had been raised by the whistleblower nurses at the end of 2002. But it is possible to conclude that the HCCC was, to some extent, made a scapegoat for some of the problems within the system. Notwithstanding those matters, the Opposition certainly supports the bills.

Although we supported the inquiry conducted by Bret Walker, we argued that a much wider inquiry of the level of a royal commission was needed, so deep were the problems that were then identified in the health system and that, apparently, were not restricted to Camden and Campbelltown. Notwithstanding that, the inquiry was conducted and these bills are an outcome of that inquiry. The proposed legislation represents a clearer direction for the HCCC, and one needs to read the overview of the bill to learn what the commission will be doing. The HCCC will focus on dealing with serious complaints concerning health practitioners, health service providers and the provision of health services. It will establish the Health Conciliation Registry as a separate unit to deal with the conciliation of complaints and to enable the commission, in appropriate circumstances, to deal with complaints through alternative dispute resolution procedures. The HCCC will be required to appoint a member of staff as Director of Proceedings to exercise the function of the commission of determining whether a complaint should be prosecuted before a disciplinary body. There will be changes to other legislation flowing from these bills.

Schedule 1 to the Health Legislation Amendment Complaints Bill will amend the principal Act—the Health Care Complaints Act—by replacing section 3 so as to make it clear that the primary object of the Act is to establish the commission as an independent body for the purpose of receiving and assessing complaints relating to health services and health service providers, investigating and prosecuting serious complaints and resolving or overseeing the resolution of complaints. The proposed section also provides that, when exercising functions under the principal Act, the primary object of the commission is the protection of the health and safety of the public. That is the background against which it is appropriate that we examine the past operations of the HCCC and why it was found to have not acted to safeguard the community in relation to the complaints raised about Camden and Campbelltown hospitals.

I now turn to the evidence given by former Health Care Complaints Commissioner Amanda Adrian to the General Purpose Standing Committee No. 2 inquiry into complaints handling within NSW Health—a committee of this House that conducted an inquiry concurrently with the Walker inquiry. Former Commissioner Adrian told that committee:

I was appointed to the position of Health Care Complaints Commissioner in 2000 with the following as my platform: providing the community with an effective, independent watchdog agency for the health system; developing the commission as an organisation that was taking a more systemic view of the challenges to safety and quality in the health system; and introducing a significant change program aimed at changing the perception of many health professionals that the commission was solely an instrument that was bent on seeking out the "bad apples" in the health system, humiliating them by investigating them and taking disciplinary action through a formal prosecution for professional misconduct. In my view, this new approach would lead to a culture of learning and a willingness to share information about errors, and the failures of the system, and it would encourage open and active discussion and improvement in health care. This is fundamental to a safe system providing high quality care.

They really are good and lofty aspirations, but it is quite clear that within the system at the time was a group of whistleblower nurses, as they became known, who recognised the problems in the system and the significant issues of concern at Camden and Campbelltown hospitals in particular. They decided to share their information, but their desire to get action was simply not taken up appropriately by anyone in the system—from the Minister for Health down. Failures in the system were not accepted; there was no sense of open and active discussion or any real attempt to improve the health care system. Rather, when we talk about shame and blame, those who received the blame in all this were the nurses. The Hon. Dr Arthur Chesterfield-Evans said that virtually all of them—I think one may still be practising in the health care system—were effectively forced out of the system. Whatever might have been the lofty aims of the Health Care Complaints Commissioner, the reality is that the culture simply did not encourage an open and active system.

This legislation will count for nothing unless the Government properly resources all its agencies, and that means, in the first place, the health department, next the area health services and then its investigative bodies. I was not present in the Chamber this morning when the Hon. Dr Peter Wong contributed to this debate; I was meeting with a large number of people who had travelled from Batemans Bay to express their concerns about the inadequacies of their hospital system. I will have something to say about that in debate on other legislation today.

However, I understand that the Hon. Dr Peter Wong suggested that the problem for the commission was not resources. That differs from evidence taken by General Purpose Standing Committee No. 2 from former Commissioner Amanda Adrian, who outlined her vision and then stated that she had encountered an enormous backlog of delayed investigations. She said they had been accumulating from the days of the complaints unit and an inability to meet the expectations of some parties, complainants and respondents, about matters under investigation. She stated it was an organisation that required a more robust system and quality measurement in a number of vital areas. Importantly, she said:

We now have these bills. However, unless the Government acknowledges its responsibility to adequately resource the commission, the objectives of the bills will count for nothing. The committee received evidence that the commission had been inadequately resourced. Indeed, it was not until Commissioner Adrian was dismissed that the Minister provided additional funding because the matter was regarded as politically hot. The Opposition welcomes the proposed legislation, although I note that it only provides the requisite framework. An important element of it is the concept of professional misconduct, which is provided for in the Health Registration Legislation Amendment Bill. Paragraph (a) of the overview to that bill states:

to standardise, as far as possible, the concepts of "professional misconduct" and "unsatisfactory professional misconduct" where used in those Acts so that they relate to conduct that demonstrates that the knowledge, skill or judgment possessed, or care exercised, by the relevant health practitioner in the practice of their profession is significantly below the standard reasonably expected of such a health practitioner of an equivalent level of training or experience.

It refers to other matters that a professional person may be accused of neglecting, such as the taking of appropriate action when complaints are made. The bill provides a clear definition of what might qualify as unsatisfactory professional conduct, and that is appropriate. I do not wish to take up too much more time of the House; the background and history of the legislation are well understood. However, I again make the point that the legislation itself will count for nothing unless the Government has the will to properly resource the Health Care Complaints Commission so that it can do its job effectively. The Hon. Dr Arthur Chesterfield-Evans and I differ on this point because he is enamoured of the approach Commissioner Adrian had in place: a systematic approach towards the health system viewed within that framework, rather than a prosecutorial approach.

The Walker inquiry highlighted that inadequate action had been taken, that clearly faults had been identified and errors made. It also found lack of professional conduct by some people and lack of appropriate follow-up. Some deaths may not have occurred if appropriate investigations had been undertaken at the right time. I do not oppose the legislation and acknowledge that it is the logical outcome of the inquiry undertaken by Bret Walker, SC. However, I reiterate that it will stand for very little unless the Government accepts its responsibilities to provide appropriate resources in order to have a proper health complaints system.

Reverend the Hon. Dr GORDON MOYES [3.15 p.m.]: It is quite clear that the main objective of the Health Legislation Amendment (Complaints) Bill, and cognate bills, is to refocus the Health Care Complaints Commission [HCCC] on investigating serious complaints about health service providers, to improve the operation of the health complaints handling process and to give proper protection to complainants, practitioners and the general public within this framework. The new objectives centre on the Health Care Complaints Commission and its complaints-handling function.

Specifically, the first objective of the bills is to refocus the HCCC on investigating serious complaints about health service providers. It will do so by providing new objectives for the HCCC, which will emphasise that its primary role is the investigation of serious complaints. The bills will clarify the definition of "unsatisfactory professional conduct", thereby giving the HCCC the flexibility to refer matters to a registration board for consideration and apply performance assessment provisions to nurses and midwives.

The second objective is to improve the operation of the complaints handling process to make it faster and more effective. It is proposed to achieve this by removing the requirement for statutory declarations to be provided by a complainant and empowering the HCCC to require the production of hospital, medical and practice records. The third main objective is to make the complainants system fairer for all parties by giving proper protection to complainants, practitioners and the general public within this framework.

Further, the bills will implement the special commission of inquiry recommendation that the HCCC must properly identify doctors and nurses who are the subject of complaints and the allegations against them. Additional protections are provided for those who make complaints. Complainants will be protected from liability if they make a complaint in good faith. The bills also propose to transfer the Health Conciliation Registry to the HCCC so that the one body can perform all dispute resolution functions. A number of safeguards have been included to ensure that the conciliation functions are kept independent of the HCCC's investigative functions. As recommended by Commissioner Walker, these changes will ensure that challenges based on oppressiveness or delays are not prevented.

I thank Justice Kenneth Taylor, who, as the new Acting Health Care Complaints Commissioner, has set the organisation on a new path towards providing a more accountable complaints process. I take this opportunity to thank also Mr Bill Grant, who stepped in as interim commissioner of the HCCC, and the New South Wales Cabinet Office for its work in the review of the Health Care Complaints Act. The bills seek to implement the recommendations of the special commission of inquiry into Campbelltown and Camden hospitals and the Cabinet Office review of the Health Care Complaints Act of 1993. A number of exposure draft bills were tabled in Parliament, together with an introductory paper, on 14 September this year.

The bills have undergone a four-week public consultation process and 20 submissions on them have been received. The Cabinet Office met with key stakeholders during this period. As honourable members would be aware, I chaired the General Purpose Standing Committee No. 2 inquiry into the handling of health complaints within NSW Health. Committee members interviewed past and present leadership of the HCCC and recognised serious delays in investigating complaints. Commissioner Amanda Adrian and others blamed lack of resources; but that was not the whole answer to the HCCC's inactivity, despite the advocacy of Hon. Dr Arthur Chesterfield-Evans.

Three bills will institute major changes to the health care system: the Health Legislation Amendment (Complaints) Bill, the Health Registration Legislation Amendment Bill and the Nurses and Midwives Amendment (Performance Assessment) Bill. On behalf of the Christian Democratic Party, I commend the initiatives introduced in these bills and I shall now comment on those bills.

The Health Legislation Amendment (Complaints) Bill establishes the Health Care Complaints Commission as an independent body for a number of stated purposes. The fulfilment of each of these stated purposes is necessary in the light of the events preceding the inquiry into Campbelltown and Camden hospitals. No doubt the commission required independent status, and the bill gives the commission that status. In matters as delicate as complaints handling for persons direly affected by the health care system it is an absolute necessity for the entity considering the complaints to be in an uncompromised position. I commend the Government's initiative in making the commission independent. The bill explicitly states:

The importance of this statement is without question. Hopefully, due service will be paid to this statement, not just lip service. The health and safety of our public cannot be underestimated. Although we in New South Wales are incredibly fortunate to have a health system that is funded by our Government, the Government should ensure that appropriate systems are in place and working effectively to safeguard the health and safety of our people. The health and safety of our people should be of utmost priority for any responsible government. The responsibilities of the Director-General of the Department of Health are clearly delineated by the bill. It seems that the director-general will be responsible for identifying any structural problems in the health system and, naturally, will be made responsible for issues of high-level concern, such as, specifically and importantly, facilitating the achievement and maintenance of adequate standards of patient care within public hospitals and in relation to other services provided by the public health system.

The bill makes investigation mandatory in cases in which either the commission or the appropriate registration authority is of the opinion that a complaint, or even part of a complaint, should be investigated. However, when neither the commission nor the appropriate registration authority is of the opinion that a complaint should be investigated, but either is of the opinion that it should be referred to the registration authority, it must be referred to the appropriate registration authority. Complaints may also be referred to conciliation in circumstances when the commissioner and the registration authority consider that the matter is appropriate for conciliation and when both entities hold the opinion that the complaint should not be investigated. Currently, the Act requires the commission to give written notice of making a complaint, the nature of the complaint and the identity of the complainant, and of the person against whom the complaint is being made, within 14 days of the commission receiving the complaint.

The bill will institute a new procedure. Rather than giving notice within 14 days of receiving the complaint, the commission will be required to give notice no later than 14 days after the commission's assessment of the complaint under division of the Act. Under the Act, the commission has 60 days in which to make that assessment. At first blush it would seem that the delay in a person against whom a complaint has been made receiving notification of certain details of the complaint could be unjust. However, it seems necessary that the commission should be given adequate time to consider whether the notice should be released in the light of such things as whether or not the notice will or is likely to prejudice the investigation of the complaint, place the health or safety of a client at risk, or place the complainant or another person at risk of intimidation or harassment.

A welcome initiative in this regard is that, even if the commission is of the opinion that certain factors exist that point towards not giving notice, the commission may give some form of notice. In essence, some form of notice of a complaint may only be given when the notice does not affect the health or safety of a client or puts any person at risk of intimidation or harassment. The commission will also be placed under an obligation to give notice, regardless of the circumstances, if it considers on reasonable grounds that it is essential on the grounds of natural justice to investigate the complaint effectively or it is otherwise in the public interest. Another important amendment relates to the withdrawal of complaints by complainants, which on one level might be seen as a matter of semantics but in fact is a matter of importance.

Currently, the commission may cease to deal with a complaint once it is withdrawn. However, it must continue to deal with the subject of the complaint if it appears to the commission that, for example, the matter provides grounds for disciplinary action against the health practitioner or the matter involves gross negligence on the part of a health practitioner. The bill omits the term "provides", replacing it with "if substantiated would provide". That means that under this amendment if the evidence would then tend to prove grounds for disciplinary action against the health practitioner, the commissioner must continue to deal with the matter. Similarly, in the second instance the term "involves" is replaced with the words "if substantiated would involve". The effect of the change in the wording of these provisions will provoke the commission to look even more closely at the evidence submitted. This is because the commission will be made to reflect upon whether or not the matter is substantiated, rather than simply making a straightforward assessment of the material concerned.

Significantly, as part of the commission's assessment procedure, the bill requires that the commissioner align the allegations comprising the complaint with the actual version of the events. Such a power is necessary for the commission to exercise its functions effectively. The bill introduces a duty for the commission to keep under review its assessment of a complaint while it is dealing with the complaint. Thus the commission is charged with a responsibility of constantly monitoring the process of the complaint and is able to take one of a number of actions, including referring the complaint for conciliation, or referring the complaint to the director-general or some other body.

The bill gives the commission the power to obtain certain medical records and documents relating to a health practitioner's practice for the purpose of assessing whether a complaint should be investigated. That is an important initiative. Information that may assist in elucidating a complaint and the facts surrounding the complaint should be made readily available and accessible. In relation to conciliation as a means of resolving a complaint, the bill widens the scope in which conciliation may be used as a tool for resolution, and also tightens the provision in relation to this means of resolution. The Christian Democratic Party is committed to the use of conciliation wherever possible, rather than taking judicial action.

Under the current bill, the commission has the discretion to refer certain complaints to conciliation, but the bill proposes that in some situations referral is mandatory. Under this bill, the commission is also given the power to refer complaints to the director-general if the commission is of the opinion that the complaint, entirely or in part, relates to a matter that could be subject to an inquiry by the director-general under the Public Health Act 1991 or the Health Services Act 1997. It is for the director-general to decide whether he or she—in this case she—will consider the complaint for these purposes. The commission may also refer a complaint to the appropriate registration authority if it sees fit to do so.

It would seem that the director-general is responsible for the performance of the health system overall and is not directly charged with the responsibility of resolving local level matters when these can be dealt with by an appropriate public health organisation. Thus the commission may refer a complaint directly to an appropriate public health organisation when the complaint is capable of resolution at a local level. The Act specifies certain circumstances in which the commission may discontinue dealing with a complaint. This is an important part of the bill. It adds an additional circumstance: that is, when a complaint, or part of a complaint, has been referred by the commission to another person or body for investigation, or for consideration of another action, including, for example, performance assessment or impairment assessment under the Health Registration Act. It is important that the other entities to which complaints are referred ensure that the complaint is appropriately dealt with.

It is incumbent on the Government to ensure that a network of relevant entities is wholly aware of its responsibilities to the public. A holistic perspective is not only necessary but also essential to the effective and efficient functioning of our health care system. Certain provisions in the Act deal with the commission giving notice to relevant parties to a complaint of the action the commission intends to take in relation to that complaint. The bill tightens those provisions. For example, the commission must give notice of its intention within 14 days. Previously there was no time stipulation.

The commission is given the discretion to give notice of the investigation of a complaint against a health practitioner to a person who currently employs or engages the health practitioner. Another important insertion is the provision that the "commission may review a decision made after assessing a complaint if requested to do so by the complainant, and must do so if the request is made within 28 days after the complainant is notified of the decision". These are some of the few initiatives that improve the notification procedures.

Proposed section 34A will empower the commission to request information that is relevant to a complaint. Such a request must be complied with if the person to whom the request is addressed is the complainant, or a person against whom the complaint was made. Persons who do not comply with such a request will be liable to a maximum penalty of $2,200. It is worthy of note that proposed section 37A relates to privilege against self-incrimination; it provides that self-incrimination may not be used as an excuse not to give information, or not to answer a question or produce a document under section 34A.

However, the same provision states that any information given by a natural person in compliance with section 34A is not admissible in evidence against the person in any civil or criminal proceedings, especially where the person objected at the time to doing so on the ground that it might incriminate himself or herself, or where the person was not warned that he or she may provide answers that might incriminate himself or herself. Thus the right of privilege against self-incrimination is preserved for civil and criminal proceedings. However, any information given in this context may be used in relation to disciplinary proceedings or proceedings for an offence under the relevant part of the Act.

The bill makes it entirely clear that the Ombudsman Act 1974 will apply to the commission. The underpinnings of this Act are essentially to provide a means for the public to make complaints to the Ombudsman and, consequently, for the Ombudsman to investigate the conduct of the public authority complained of. The function of the Ombudsman is to ensure that authorities remain accountable to the public. Importantly, the commission is also not precluded from providing information to the Ombudsman for the purposes of an investigation under the Ombudsman Act. One of the most important functions carried out by the commission is its conciliatory function. The bill clarifies the provisions relating to conciliation. One pertinent example is the note to proposed section 49, which says:

A conciliator has no power to impose a decision on the parties, to make a determination or to award compensation.

Sometimes, resort to legal methods of complaint resolution instigates an expectation that due compensation will be paid out. It is important for the public to be made aware of their standing and the outcomes they can expect once they resort to legal methods of complaint resolution. Also, it was apparent during General Purpose Standing Committee [GPSC] No. 2 deliberations that a number of persons making complaints would have been satisfied with a simple apology. A brief extract was submitted to GPSC No. 2 hearings from a statement made by the mother of a child who died in hospital. The mother said:

We later found out that the doctor wanted to be the one to tell us [about the child's death]. He wanted to tell us then and there but the hospital protocol did not allow it. I had to wait 10 months to hear, "I'm sorry."

The nurse that was involved in the procedure—and I remember this distinctly—spoke in a most moving way. The mother said:

We had to wait 10 months to meet her, and she was banned from approaching us. And we were actually at the Coroner's Court. I am standing in the line to the ladies toilet. I am in a public toilet and the lady's standing behind me, I happened to recognise her, and I said, "You are one of the nurses from the hospital, aren't you?" She said, "I am the nurse." She breaks down and cries and I break down and cry. And this is all happening in the public toilet, the last place this should happen. It is one of the most emotional meetings I have ever had, and all she ever wanted to say to me was, "I'm sorry" and all she could keep saying was, "I'm sorry, I'm so sorry." We ended up embracing and it was something we needed to do. I needed to hear that "I'm sorry" and she needed to say it. And it is happening in the public toilet. It is something the hospital should have organised.

Discussion in GPSC No.2 also touched on what patients want when something goes wrong. Research indicates that when something goes wrong with their health care, patients want to know about it. The interpretation of all the literature about what patients want when things go wrong is, "Please tell us what is happening?". Or, in the case of a patient's death, "Please tell us what went wrong." In the health system this is usually referred to as "open disclosure": proactively providing patients or families with a full explanation of the causes of their condition and entering into discussion with the patient about their future care and treatment implications. The provision of timely and frank information about an adverse event not only helps patients come to terms with their situation, or about what really did happen, but, if properly managed, may reduce the likelihood that they will take legal action, contradicting the generally held view that admitting mistakes is likely to lead to litigation.

NSW Health acknowledged that many of the complaints arising from Campbelltown and Camden hospitals were, in part, due to poor communication by doctors to families about the patient's condition and treatment. NSW Health has also indicated that communication is a key area in which improvements need to be made and is committed to this, which was acknowledged by our committee. During the inquiry the committee heard of many instances of where either NSW Health or health professionals failed to communicate effectively with relatives affected by adverse events. As the case studies show, the failure to adequately consult with or inform patients or their families about their treatment can have far reaching and damaging consequences.

Another salient point relates to the establishment of the health conciliation registry within the commission. The Christian Democratic Party supports this. Currently the registry is a statutory corporation that is charged with arranging and facilitating the conciliation of complaints. The introduction of the office of Director of Proceedings is a welcome initiative. The person serving as Director of Proceedings will do such things as "determine whether the complaint should be prosecuted before a disciplinary body and, if so, whether it should be prosecuted by the commission or referred to another person or body for prosecution".

The director is also given power to "intervene in any proceedings that may be taken before a disciplinary body in relation to the complaint". It is also important to note that the director is to take account of a number of matters, including the protection of the health and safety of the public and the seriousness of the alleged conduct the subject of the complaint, when deciding whether a complaint should be prosecuted before a disciplinary body. The bill will also ensure the director's independence from the commission.

I will speak briefly on the two cognate bills. One of the main objectives of the Health Registration Legalisation Amendment Bill is to standardise the concepts of "professional misconduct" and "unsatisfactory professional conduct" in legislation dealing with myriad health-related professions. The legislation will affect doctors, chiropractors, dentists, nurses, optometrists, osteopaths, physiotherapists, podiatrists, and psychologists. The bill expands the phrase "unsatisfactory professional conduct" to include "conduct that demonstrates that the knowledge, skill or judgment possessed, or care exercised, by the relevant health practitioner in the practice of their profession is significantly below the standard reasonably expected of such a health practitioner of an equivalent level of training and experience". The bill will make a contravention of proposed section 34A (4) of the Health Care Complaints Act by health practitioners—which relates to requirements to provide information to the Health Care Complaints Commission—a type of unsatisfactory professional conduct under the relevant Acts.

I conclude by referring to the Nurses and Midwives Amendment (Performance Assessment) Bill. The object of that bill is to amend the Nurses and Midwives Act 1991 to include provisions enabling assessments of the "professional performance" of nurses and midwives in order to mirror those existing in the Medical Practice Act 1992. "Professional performance" refers to the knowledge, skills or care possessed and applied by nurses or midwives in the completion of their responsibilities as a nurse or midwife. Ensuring that the work of nurses and midwives is being carried out at satisfactory levels is of utmost importance to a sound health care system, and any measures that support this stance ought to be supported. I realise that these are important bills and that is why I have taken some time to outline their support by the Christian Democratic Party.

The Hon. JOHN DELLA BOSCA (Special Minister of State, Minister for Commerce, Minister for Industrial Relations, Assistant Treasurer, and Minister for the Central Coast) [3.41 p.m.], in reply: I thank honourable members for their contributions to the debate. The proposed amendments implement the recommendations—this has been canvassed a number of times by speakers in the debate—of the Special Commission of Inquiry and the Cabinet Office review designed to support the recommendations. The bills will streamline the complaints handling process and focus the Health Care Complaints Commission [HCCC] on ensuring that practitioners who are the subject of serious complaints are individually accountable.

The Government appreciates the input of the stakeholders who provided submissions on the bills, and it has given careful consideration to their views. The Government intends to move an amendment in response to a concern expressed by the Legislative Review Committee about proposed amended section 35 (d) of the Health Care Complaints Act. The amendment will clarify that in order to be guilty of the offence of furnishing false or misleading information to the Health Care Complaints Commission a person must know that the information furnished is false or misleading.

The Hon. Robyn Parker made a number of points on behalf of the Opposition. The Health Care Complaints Commission has an annual budget of $7.2 million, which it has received for the past four years. In addition, in February this year the Government gave the HCCC an additional $5.7 million over 15 months to enable the commission to deal with the backlog of complaints and with matters arising from the Special Commission of Inquiry. The commission expects to have dealt with the backlog of complaints entirely by early next year.

The Special Commission of Inquiry made no recommendations about the funding of the HCCC, as I believe the Hon. Robyn Parker observed. The HCCC is now likely to be more efficient in its use of resources, due to the new management of the commission, the commission's new powers to obtain information, its renewed focus on the core business of investigating serious complaints, and other reforms in the bill that will streamline the complaints handling process in general.

The Hon. Robyn Parker referred to the appointment of the Director of Proceedings. The proposed amendment to the Health Care Complaints Act provides for the commission to appoint a member of its staff to be the Director of Proceedings. This is appropriate because the new office of the Director of Proceedings will form part of the commission. It is only right that the commissioner, who will ultimately be accountable for the overall performance of the commission, including the prosecution function, has the freedom to select HCCC staff members as appropriate. The independence of the Director of Proceedings is ensured by the Act, which provides that the Director of Proceedings is not subject to the direction and control of the commissioner of the HCCC when dealing with a complaint.

The Hon. Dr Peter Wong made a number of points about the proposed integration of the Health Conciliation Registry with the HCCC. In the Government's view the integration will ensure that the existing conciliation service is better used, and that all alternative dispute resolution functions are performed by the same body. I think the honourable member asserted that there were insufficient, or no, safeguards. The safeguards included in the bill to ensure that the conciliation function remains independent include the statutory recognition of the separate role of the registry; providing that the registry and conciliators are independent of the commission when conducting conciliations; offence provisions to prevent the unauthorised disclosure of information obtained by registry staff or conciliators as part of their duties; and giving the parliamentary joint committee a role in overseeing the operation of the registry. I commend the bills to the House.

Motion agreed to.

Bills read a second time.

In Committee

The CHAIRMAN: The Committee will deal first with the Health Legislation Amendment (Complaints) Bill.

Clauses 1 to 4 agreed to.

The Hon. JOHN DELLA BOSCA (Special Minister of State, Minister for Commerce, Minister for Industrial Relations, Assistant Treasurer, and Minister for the Central Coast) [3.47 p.m.]: I move Government amendment No. 1:

Page 16, schedule 1 [30], line 21. Omit "that is". Insert instead "knowing that it is".

The Legislation Review Committee expressed concern, which was echoed by honourable members in the second reading debate, about proposed amended section 35 (d) of the Health Care Complaints Act. The existing offence of furnishing false or misleading information to the Health Care Complaints Commission states that the person must know that the information is false or misleading. The Legislation Review Committee has noted that in the bill the explicit requirement of "knowledge" as an element of the offence has been omitted.

As is clear from the extensive material released as part of the Cabinet Office review, it is not the Government's intention to make a policy change of this kind. Removal of the "explicit knowledge requirement" occurred inadvertently in the course of drafting. I am advised that the omission of the express reference to knowledge would not necessarily affect the interpretation of the offence, but to put the issue beyond doubt, the Government has moved the amendment. The amendment makes it clear that a person must know that the information furnished is false or misleading.

Amendment agreed to.

Schedule 1 as amended agreed to.

Schedules 2 to 4 agreed to.

Title agreed to.

The CHAIRMAN: The Committee will now deal with the Health Registration Legislation Amendment Bill.

Clauses, schedule and title agreed to.

The CHAIRMAN: The Committee will now deal with the Nurses and Midwives Amendment (Performance Assessment) Bill.

Clauses, schedule and title agreed to.

Health Legislation Amendment (Complaints) Bill reported from Committee with an amendment, and cognate bills reported without amendment, and bills passed through remaining stages.

GENERAL PURPOSE STANDING COMMITTEE NO. 1

Government Response to Report

The Hon. Ian Macdonald tabled the Government's response to Report No. 24, entitled "Serious Injury and Death in the Workplace", dated 17 May 2004.

Ordered to be printed.

BUSINESS OF THE HOUSE

Suspension of Standing Orders

Motion, by leave, by the Hon. Ian Macdonald agreed to:

That standing orders be suspended to allow a motion to be moved forthwith to rescind the resolution of the House this day that the third reading of the Gene Technology (GM Crop Moratorium) Amendment Bill 2004 be set down for the next sitting day.

GENE TECHNOLOGY (GM CROP MORATORIUM) AMENDMENT BILL

Third Reading

Motion by the Hon. Ian Macdonald agreed to:

That the resolution of the House this day that the third reading of the Gene Technology (GM Crop Moratorium) Amendment Bill 2004 be set down for the next sitting day be rescinded.

Resolution for third reading rescinded.

The Hon. IAN MACDONALD (Minister for Primary Industries) [3.55 p.m.]: I move with concurrence:

That this bill be now read a third time.

The Hon. DUNCAN GAY (Deputy Leader of the Opposition) [3.56 p.m.], in reply: The bill as amended in Committee is better than the original bill the Government introduced. The amendments that have been moved and accepted by the Government, as few as they are, have made it better than it was, but it is still not good enough to grant exemptions in this area. There is no surety with regard to insurance, third party liability, and other issues the Opposition raised. Notwithstanding that the Opposition believes that the bill has been improved, it will vote against the third reading.

The Hon. IAN MACDONALD (Minister for Primary Industries) [3.56 p.m.]: I appreciate the unusual nature of the contribution of the Deputy Leader of the Opposition. It is extraordinary to vote against a bill even though it is an improvement on the original version. If the Deputy Leader were successful in voting against the third reading, we would revert to the original version. The Deputy Leader has admitted that the amendments have made this version better than the original version. It is an extraordinary situation for an Opposition that wants some credibility—

[Interruption]

The DEPUTY-PRESIDENT (The Hon. Patricia Forsythe): Order! The Minister has the call.

The Hon. IAN MACDONALD: If the amended bill is defeated today we will revert to the original bill, which honourable members opposite say is not as good as the amended bill. Any sensible, serious legislator who has accepted that this bill is a bit better than the original version—even if he did not like it and voted against various parts—would vote for it on that basis. This is an outstandingly unusual position for an Opposition to take.

Question—That this bill be now read a third time—put.

The House divided.

Ayes, 19

Ms Burnswoods
Mr Catanzariti
Mr Costa
Mr Della Bosca
Mr Egan
Ms Fazio
Ms Griffin

Mr Hatzistergos
Mr Jenkins
Mr Kelly
Mr Macdonald
Reverend Dr Moyes
Reverend Nile
Mr Obeid

Mr Oldfield
Mr Tingle
Mr Tsang

Tellers,
Mr Primrose
Mr West

Noes, 15

Mr Breen
Dr Chesterfield-Evans
Mr Clarke
Mr Cohen
Mrs Forsythe
Mr Gallacher

Mr Gay
Ms Hale
Mr Lynn
Ms Parker
Mr Pearce
Ms Rhiannon

Mr Ryan

Tellers
Mr Colless
Mr Harwin

Pairs

Ms Robertson	Ms Cusack
Mr Roozendaal	Miss Gardiner
Ms Tebbutt	Mrs Pavey

Question resolved in the affirmative.

Motion agreed to.

Bill read a third time.

STOCK MEDICINES AMENDMENT BILL

Second Reading

The Hon. IAN MACDONALD (Minister for Primary Industries) [4.04 p.m.]: I move:

I seek leave to have the second reading speech incorporated in Hansard.

Leave granted.

Stock Medicines Act

Stock Medicines Act 1989

Stock Medicines Amendment Bill

The Hon. DUNCAN GAY (Deputy Leader of the Opposition) [4.05 p.m.]: The Opposition does not oppose the Stock Medicines Amendment Bill, which amends the principal Act, the Stock Medicines Act 1989. By way of background, this Act is intended to ensure that animal products consumed by humans are not contaminated with stock medicines, trade in animals is not affected by residues, and stock medicines are used appropriately and effectively. The objects of this bill are to impose further safeguards in relation to the use of stock medicines on major food-producing species. These are defined as cattle, sheep, pigs or chickens or any other species prescribed by the regulations.

Ensuring that animal products are not contaminated by stock medicines and residues is extremely important. Residue-affected livestock has the potential to cost producers millions of dollars in the loss of export and domestic markets. As I am sure all honourable members are aware, the bill comes before the House at a time when farmers are fighting one of the worst locust plagues in 30 years, brought on by the inaction of this Government and the inability of this Minister to grapple with the problem properly.

I have been approached by a number of farmers who hold concerns that some locust control chemicals have high residue and withholding periods that may adversely affect livestock targeted at export markets that are grazed on land that has been sprayed. It is not just stock diseases that we need to be wary of; we also need to be careful of chemicals and residues used in farming activities other than livestock. The bill enables the use of stock medicines intended for a major food-producing species on stock of some other food-producing species so long as certain requirements are complied with. It ensures that relevant instructions are given to the owner or person in charge of stock in relation to the treatment of stock with a stock medicine.

The bill also removes certain offences relating to the advertising of stock medicines and extends the grounds on which orders may be made under the Act prohibiting or regulating the use of a stock medicine or recalling stock medicine. The legislation repeals provisions of the Act, the operation of which is currently suspended under the Agricultural and Veterinary Chemicals (New South Wales) Regulation 2000 because those provisions are covered by Commonwealth law. In addition to making a number of miscellaneous amendments, the bill enables penalty notices to be issued for offences against the Act or the regulations.

The bill implements the results of two national competition policy reviews: a national review of Federal agricultural and veterinary chemical legislation and a separate State review of the New South Wales Stock Medicines Act 1989. The bill also modernises the Act and improve its efficiency, and I congratulate the Government on that measure. It removes from the Act the offence of using an unregistered stock medicine on stock that is not a member of a food-producing species. It prevents a veterinary surgeon from prescribing or supplying an unregistered stock medicine for use on stock that is not a member of a food-producing species unless, of course, the stock medicine complies with certain requirements.

Owners of companion animals have used unregistered stock medicines on their animals for a number of years with no indication of any real risk to the animals or the community. Consequently, the bill will remove the previous restrictions on this use. For example, owners of companion animals will now be able to use cat worming tablets to treat dogs, and vice-versa. Some additional restrictions are being implemented in accordance with the agreements coming out of the national competition policy review. The first is a ban on the use of oral or topical products by injection. The Opposition supports this ban as it could pose a risk to the animal and could also change the residue profile of the product. As it may also cause illegal or unsafe residues in food-producing animals, this ban fulfils an important function in protecting both our livestock and consumers. The bill proposes that all users of stock medicines, including veterinary surgeons, must comply with a new category of restraints.

This will ensure that controls in New South Wales, especially in regard to the use of important antibiotic products, properly reflect the risk assessments carried out by the Australian Pesticides and Veterinary Medicine Authority. The Opposition supports those provisions within the bill that continue to allow veterinary surgeons to use and prescribe products off-label, but not in cases where there are specific restraints. This includes preventing the use of antibiotics from being used in food-producing animals. The bill specifies that veterinary surgeons will be permitted to treat animals of a major food-producing species only with a product that is already registered for the treatment of another major food-producing species, and that is a reasonable measure. This means that food-producing species will be treated with products that have been assessed as suitable for human consumption.
The Opposition welcomes the extensive consultation with livestock industries and the veterinary profession in the preparation of this legislation. That is unusual for this Minister. The Opposition has been advised that the New South Wales Farmers Association, representing livestock industries, has no major concerns with this bill. Indeed, representations have not been made by the even larger number of farmers who are not members of the association. The Opposition believes that farmers will benefit from the legislation by virtue of the provision of some new flexibility in relation to minor or innovative livestock industries. There are few, if any, registered products available to treat unusual animals, including deer, alpaca or emus.

The amendments encompassed in the legislation will allow the use of stock medicines registered for these and other species, provided that they do not increase the label dose. Under the new legislation farmers are also required to apply an appropriate withholding period using the label-withholding period as a minimum. This period will be set in consultation with the veterinary surgeon. Once the withholding period is established, farmers will not have to continually seek written approval to use the product. This will provide producers with limited power to use certain stock medicines off-label in low-risk situations without routine veterinary intervention, thus saving them a great deal of time and, in some cases, money. The bill makes changes to definitions of food-producing species under section 3 of the Act.

These are now categorised as either food-producing species or major food-producing species. The Opposition welcomes the fact the bill provides for other animals to be prescribed in the regulations once the amendments are implemented, and if their importance as food-producing animals increases in future. This recognises the importance of major species as food in the Australian market and also their significance to our international trade. The veterinary profession was closely consulted on this bill through the Australian Veterinary Association and former national registration authority, the Australian Pesticides and Veterinary Medicines Authority. I am aware that the Australian Veterinary Association recognised the validity of basic national controls and was keen to see them established in a consistent manner.

The association has supported the identification of treated animals and the keeping of records of such treatment. As the keeping of records is good veterinary practice, in the majority of cases veterinarians would already be doing this. Such provisions will ensure veterinary surgeons are accountable for any residues that may arise in circumstances where the veterinarian is responsible for determining the treatment administered to an animal. It also ensures that any residues arising from treatments to food-producing animals can be traced. I am aware that during consultation in regard to the national competition policy review of the bill the Australian Veterinary Association raised questions about certain issues, including the wording of the proposed controls where such wording may imply that veterinary surgeons were required to authorise uses of certain products.

The Opposition is aware that this was addressed in consultation with the association, which is now satisfied with the amendment. We welcome the fact that requests by the Australian Pesticides and Veterinary Medicines Authority regarding off-label treatment of food animals and appropriate use of label restraints statements were addressed in the final proposal. The bill repeals the advertising provisions in the Act, which the National Competition Council considered as being anti-competitive, when alternative national controls commence under the Agricultural and Veterinary Chemical Code Act 1994. The new legislation will take affect upon proclamation, not assent, to allow time for such national controls to be developed. In conclusion, the Opposition does not oppose the Stock Medicines Amendment Bill. It is a practical piece of legislation designed to protect consumers of food derived from stock and livestock industries, while providing limited freedom for producers to use some over-the-counter products without veterinary supervision.

Mr IAN COHEN [4.08 p.m.]: I shall briefly speak on the Stock Medicines Amendment Bill, which the Greens do not oppose. We acknowledge the existence of chemicals and their residues in stock that will be used for food products and agree that this area requires regulation. We support added restrictions on stock medicines to be used for major food-producing species and registration of the use of such chemicals by veterinary surgeons. We agree that the liability and accountability measures in the bill are a step in the right direction. Chemical use is widespread in animal husbandry in this State and control is required to avoid contamination by harmful chemicals, such as helix, which had a major impact on our beef exports and adversely affected Australia's reputation as a clean exporter. As a Green I constantly refer in this House to Australia's reputation overseas. This amendment to the Stock Medicines Act 1989, which will improve the Act and its efficiency, is a step in the right direction to guarantee that we have a tighter regulatory regime while also allowing, in certain circumstances, the use of over-the-counter products for individuals who need to use stock medicines on companion animals and the like.

The Greens do not oppose that. However, we believe that the chemicals used in agriculture, and in animal husbandry in particular, need greater scrutiny. Often the significant use of veterinary products and chemicals is part and parcel of normal animal production. However, the Greens are concerned about animal production that facilitates the need for ever-increasing amounts of antibiotics and other veterinary chemicals. I refer particularly to factory farming, where animals are often kept in inhumane circumstances. It may be efficient but it is not natural, and animals living in such circumstances are prone to contract various diseases from which they would not otherwise suffer and, therefore, certain practices have to be undertaken. That may involve the significant use of antibiotics and other veterinary products.

While such use may be below the standards set out in the bill, the Greens believe that the increasing use of various veterinary and agricultural chemicals and medicines in farming practices is dangerous. So any regulation is welcomed. That is important for consumers' rights and environmental issues, as residue from these chemicals may get into the environment as a result of intensive factory farming. It is necessary to be extremely cautious. The industry undertakes a level of checks and balances in terms of the agricultural medicines and chemicals used in factory farming, especially as the animals do not live naturally, to ensure that the level of veterinary medicines and chemicals used is not too high in relation to safe consumption.

That is a subjective opinion, and I appreciate that there are controls and standards. Interestingly, the growth in acceptance of and encouragement for organic industries is significant. Organic industries have great potential in the general market in Australia because of concern about. GE products. Indeed, that matter was raised during debate on the gene technology bill, which the Greens and The Nationals did not support. The Greens are concerned about the many unknowns in intensive farming practices. We want to encourage farming practices that minimise the use of chemicals and veterinary medicines. As such, the Greens do not oppose the Stock Medicines Amendment Bill.

The Hon. Dr ARTHUR CHESTERFIELD-EVANS [4.24 p.m.]: The Australian Democrats note the conclusion of the Legislation Review Committee, which wrote to the Minister regarding the appointment of authorised officers under proposed section 60A. Such officers can impose penalties of up to $44,000, but the bill does not prescribe any qualifications for such officers. A police officer is mentioned as an example. The Minister in his reply said that the director-general would not appoint anyone without appropriate qualifications and experience. If that is the intention, it would be good if that were written into the bill, because we need to be sure that people who have this amount of power know what they are doing.

The Democrats are also concerned about items [21] and [37] schedule 1, which remove the power to regulate the advertising of stock medicines. In particular, they remove the penalties that can be imposed for faulty or misleading advertising and for advertising stock medicines for purposes for which they are not registered. The question is whether such regulations can be made under the Federal Agricultural and Veterinary Chemicals Code. Sections 84, 88 and 89 of the code state:

Make claims, or permit claims to be made, about registered agricultural or veterinary chemicals that are inconsistent with instructions on the approval label.

Place and publish an advertisement or notice that offers to sell or invites someone to buy an unregistered agricultural or veterinary chemical, unless an application for registration has been made with NRA and the advertising states that fact and advises that the chemical is not yet registered.

Make claims or permit claims to be made that are incorrect, false or misleading. This includes implying the NRA or any Commonwealth, State or Territory Department recommends the product.

Given that the pharmaceutical industry, sadly, has been irresponsible in its marketing, in countries that have removed restrictions on the advertising of pharmaceuticals there have been big changes in consumption patterns, with the consumption of medicines that were often not needed and which effectively are a misdirection of the health resources of the nation, to put not too fine a point on it. The regulation of advertising is an important subject. It is my position that people should have responsibility in proportion to their power. Industries that have the power to influence consumption patterns at a national level must be responsible for the consequences of the changes in those consumption patterns. That principle has put pressure on McDonald's with regard to childhood obesity and the consumption of junk foods—

The Hon. Catherine Cusack: Individuals are responsible for what they consume.

The DEPUTY-PRESIDENT (The Hon. Patricia Forsythe): Order! The Hon. Dr Arthur Chesterfield-Evans has the call.

The Hon. Dr ARTHUR CHESTERFIELD-EVANS: It is difficult to speak when someone is interrupting. I propose to wait to collect my thoughts for however long it takes. If the interjections interrupt my train of thought I propose to wait until they have cleared and my thought processes have come back. Should that take half the afternoon, that will be on the head of the interjectors. The power of advertising is extremely important. The general sniggering is much to be regretted and shows just how little thought is given to the power of advertising. The irresponsibility of pharmaceuticals, the changes in consumption patterns in New Zealand, the effect of advertising of medicines to doctors and their prescribing habits have all been told by groups such as MaLAM, the Medical Lobby for Appropriate Marketing, now called "Healthy Scepticism", and others concerned about the effect advertising of medicines has on health. The advertising of medicines in the public domain has been regarded as even more important than in professional journals, because the readers of professional journals, one hopes, are sophisticated and aware of the possible effects of advertising. Advertising in professional journals is quite serious because of the distorting effect it has on the item being advertised. Papers such as the Land—

The Hon. Duncan Gay: Point of order: I take a point of order on relevance. On my reading of the objects of the bill, the bill has nothing to do with advertising, least of all medical advertising. I request that you draw the honourable member back to the subject matter of the bill.

The Hon. Dr ARTHUR CHESTERFIELD-EVANS: To the point of order: I find these continual points of order from the Leader of The Nationals extremely offensive. The minute I endeavour to make a point from the general to the particular, from the general aspect of advertising to the advertising of pharmaceuticals, I am interrupted by frivolous points of order. I had referred to the content of newspapers and to the Land. I was about to refer to stock medicines and to talk about their general advertising. I had moved from general concerns about advertising to concerns about this bill and why the regulation of advertising should be preserved. I had been developing these claims for not more than five minutes and I was interrupted by a silly diatribe from a member who is quite happy to talk for 20 minutes about nothing when it suits him.

The DEPUTY-PRESIDENT (The Hon. Patricia Forsythe): Order! The Hon. Dr Arthur Chesterfield-Evans should not debate the issue; he should address the point of order.

The Hon. Dr ARTHUR CHESTERFIELD-EVANS: My point is that my comments about advertising are extremely relevant to this bill, and I was on my way to proving just that. I have been interrupted and I would like permission to continue my sensible approach to advertising.

The DEPUTY-PRESIDENT (The Hon. Patricia Forsythe): Order! It is not a question of my giving the member permission to continue. Although the Hon. Dr Arthur Chesterfield-Evans may speak generally about advertising, I remind him that it behoves him to address the specific objectives of the bill.

The Hon. Dr ARTHUR CHESTERFIELD-EVANS: Thank you, Madam Deputy-President, I acknowledge your ruling. As I was saying, advertising in the Land has considerable impact on the content of the Land. I had a friend who was involved in—

The Hon. Catherine Cusack: Point of order: The Hon. Dr Arthur Chesterfield-Evans acknowledged the ruling of Deputy-President Forsythe but then continued from where he left off. He is treating the ruling with contempt. He has not been able to demonstrate where advertising in medical journals is relevant to the objects of the bill. He launched a personal attack on the Deputy Leader of the Opposition, saying that it was churlish of the Deputy Leader of the Opposition to take a point of order, but he did not address the point of order himself. Again, I ask you to draw the honourable member back to the subject matter of the bill.

The Hon. Dr ARTHUR CHESTERFIELD-EVANS: To the point of order: I was talking about the effect of advertising. This bill will change laws in relation to advertising. I was speaking about advertising and its effect on the content of journals, which affect very much the way stock are managed by farmers, and that is extremely important to husbandry, to which this bill is related. I argue that what I am saying is absolutely relevant to the bill. The Opposition is merely being churlish in taking the point of order. There is no point of order and what I am saying is exactly on the subject of the bill.

The DEPUTY-PRESIDENT (Reverend the Hon. Fred Nile): Order! The member will confine his remarks to subject matter of the bill and not embark on a general discussion about advertising.

The Hon. Dr ARTHUR CHESTERFIELD-EVANS: Items [21] and [37] of schedule 1 to the bill will remove the power to regulate the advertising of stock medicines. In particular, they will remove the penalties that can be imposed for faulty or misleading advertising and for advertising stock medicines for purposes for which they are not registered. These are extremely important provisions in that they weaken the power to regulate advertising. I contend, given the power of advertising to influence husbandry practices and the chemical environment in which stock exists—and the chemical environment consequently in which the population exists—that the Government should not give up the power to regulate advertising. Advertising in the Land affects the content of all articles in the Land.

The Hon. Ian Macdonald: The Land newspaper?

The Hon. Dr ARTHUR CHESTERFIELD-EVANS: Yes, the Land newspaper. A friend of mine conducted research into organic farming involving non-chemical—non-medicinal, if you like—treatment of stock and the breeding of stock resistant to worms, as opposed to the practice of having to squirt worm medicine into the mouths of cattle. He found that because the Land took so many advertisements for stock medicines, such as anti-worming mixtures, it was difficult to have published in that newspaper articles about breeding worm-resistant stock. If ever such an article were to appear in the paper, there would be a flurry of advertisements and another article would be published stating that although the theories about breeding worm-resistant stock were being developed, the standard practice was to use chemicals.

In other words, chemical advertising has a double effect: the effect the advertising has on those reading the newspaper, and its effect on the content of the paper. This advertising must be accurate and it must be regulated. The Government must have the power to monitor it and to enforce reasonable practice. The key point is that the Government should not surrender the power to regulate advertising.

As a further example on this point, in the early 1980s the editor of the Medical Journal of Australia, Alan Blum, resigned because the journal's content was being influenced by the marketing department and its relationship with advertisers. This is a crucial aspect of consumption patterns with regard to drugs and medicines, and that will be critical to our practices and our diets. To suggest that my contribution is beyond the scope of the bill is nonsense. It is right on the bill. The Australian Democrats are quite concerned about this aspect of the bill. Any suggestion that government control of advertising should be abolished—which no doubt comes from the stock medicines industry itself—should be resisted. I am disappointed that this Government has not done a better job of resisting that suggestion or of at least placing this power within a more sensible national framework, because increasingly advertising, even in print, should be regulated at the national level. I give notice that I will be moving amendments in this regard.

Reverend the Hon. Dr GORDON MOYES [4.40 p.m.]: I speak on behalf of the Christian Democratic Party on the Stock Medicines Amendment Bill, the motivation for which is to make amendments to the Stock Medicines Act 1989, to implement the results of the two National Competition Policy reviews on stock medicine use. The Stock Medicines Act 1989 primarily governs the use of stock medicines in New South Wales. Stock medicines are also known as "veterinary chemicals" in other Australian States. One of the main purposes of the Act is to regulate stock medicines in order to ensure that products consumed by humans are not contaminated by stock medicines. The first review, conducted by the Commonwealth Government in 1999, was a national review of Federal agricultural and veterinary chemicals legislation. The second was a separate State review of the New South Wales Stock Medicines Act 1989. The bill proposes a number of incidental amendments to update the Act and improve its efficiency. It is said that the bill will bring the New South Wales Act up to speed with the agreed national framework on stock medicine use.

The Christian Democratic Party supports the proposed changes to the New South Wales Stock Medicines Act 1989. Given that the changes will primarily bring regulation of stock medicines in New South Wales up to the standards derived at the Federal level, I do not see any great problems with them. As was said by another member earlier, there is a great future for organic farming, but this does not mean that we should ignore the use of chemicals and medicines in general farming. Some of the major provisions for change are as follows. The bill proposes a redefinition of the objects of the Act to include the protection of human health by early intervention in the agricultural production process, the facilitation of international trade by ensuring that New South Wales chemical residue standards are on par with standards set by international trading partners, and the protection of the welfare of animals treated with stock medicines. The inclusion of these objects is vital for the correct interpretation of the statutory provisions of the Act. When a provision is, on its face, ambiguous, recourse is had to the general context of a bill and, of course, to its objects. An appropriate guiding light to the way a provision is to be interpreted in the form of a clearly attainable object is commendable. In brief, any product used with any stock used for human consumption must be suitable for food produced for humans.

A number of strict liability offences are created by the bill. This means that the prosecution need not prove that the offender had the intention of committing an offence; the prosecution need only prove, in order to secure a prosecution, that the offence was committed. This is the legal principle known as mens rea. An example of such an offence is the use of unregistered stock medicine without authorisation, the maximum fine for which is $22,000 for an individual or $44,000 for a corporation. Another example is when a veterinary surgeon prescribes stock medicines contrary to the Act. As noted by the Legislation Review Committee, strict liability offences should only be applied when it is in the public interest because, generally, criminal intent must be proved by the prosecution as an element of an offence. But strict liability offences ought to apply when there is a need for persons to act with the utmost diligence and care, especially when human health is potentially at risk by acts or omissions. As the Legislation Review Committee stated:

Given the objects of the Act, the need for persons dealing with stock of a food producing species to be attentive to compliance with controls on using stock medicines, and the proportionality of the penalty to the offence, the Committee does not consider that these strict liability offences trespassed unduly on personal rights and liberties.

I take the liberty of trying to explain that in simple terms. It means: Abuse these substances and you will cop it! The bill provides that records must be kept by veterinary surgeons of certain treatments and prescriptions relating to stock medicines. Though it may be said that this is common practice, there is no harm in legislating such a requirement. The bill requires veterinarians to provide relevant instructions to the owner or person in charge of stock relating to the treatment of that stock with a stock medicine. Again, we would expect that to happen. Given the position of authority and expertise exercised by veterinarians, this provision is a welcome addition to the raft of initiatives introduced by the bill to ensure that veterinarians exercise a high degree of care in providing such services. This is particularly so as many of the stock medicines now available are highly potent.

The bill will allow a person to use a stock medicine intended for a major food producing species on stock of some other food producing species so long as certain requirements are complied with. The bill removes certain offences relating to the use of unregistered stock medicines on animals that are not of a food producing species. For example, persons may give aspirin to their cat or worm tablets designed for cats may be given to dogs. The Hon. Dr Arthur Chesterfield-Evans referred to advertising of stock products. I will not revisit that argument. The only provisions in this bill concerning the advertising of stock medicines are those that relate to the removal of offences for advertising stock medicines, an initiative taken as a result of a move to control advertising on a Federal level. In July this year the Australian Health Ministers Conference recommended to the Council of Australian Governments that all controls on the advertising of agricultural and veterinary products should be included in the Agricultural and Veterinary Chemicals Code Act, which is administered by the Australian Pesticides and Veterinary Medicines Authority. A consistent, uniform code in this area will be beneficial to advertisers, given that certainty and clarity will hopefully be the result of a national advertising standard.

The grounds upon which orders may be made under the Act prohibiting or regulating the use of stock medicines or their recall are extended by the bill. The bill also repeals provisions of the Act, the operation of which is currently suspended under the Agricultural and Veterinary Chemicals (New South Wales) Regulations 2000 because the provisions are covered by Commonwealth law. The bill will enable penalty notices to be issued for offences against the stock medicine legislation. For example, the proposed provisions. will make veterinary surgeons legally responsible if they provide inappropriate advice that results in illegal residues in animals under their care.

Proposed section 60A will enable authorised officers to issue such penalty offences. However, as pointed out by the Legislation Review Committee, the bill does not provide requirements regarding the qualifications or attributes of persons who may be authorised for the purposes of proposed section 60A. It is of utmost importance for legislation to provide statutory limits on those who may exercise administrative powers, especially when such persons are in a position to issue penalty notices. In brief, the Christian Democratic Party supports the Stock Medicines Amendment Bill, primarily because what we feed to animals may end up in the human health chain. Therefore, we must regulate the use of stock medicines in farm animals that are used for human consumption.

The Hon. IAN MACDONALD (Minister for Primary Industries) [4.49 p.m.], in reply: I thank the honourable members for their contributions to the debate, particularly the Deputy Leader of the Opposition, who made a very cogent and insightful speech. I note the concerns of the Hon. Dr Arthur Chesterfield-Evans about advertising controls, which are being repealed at the direction of the National Competition Council. The Department of Primary Industries does not consider that this direction is appropriate, but it concedes that it would be extremely difficult to argue against it.

The national review of drugs, poisons and controlled substances, known as the Galbally review, recommended such an appeal only when alternative national legislation was in place. The repeal of the provisions will not be enacted until that has happened. If this does not happen, New South Wales will be completely out of step with the other jurisdictions in relation to these controls. In other words, the advertising provisions are directed out of a national framework that is being developed and that will be implemented only when the national legislation is enacted. I remind the House also that the registration and control-of-use provisions for stock medicines remain with the Australian Pesticides and Veterinary Medicines Authority. I thank honourable members for their contributions and commend the bill to the House.

Motion agreed to.

Bill read a second time and passed through remaining stages.

BUSINESS OF THE HOUSE

Postponement of Business

Government Business Orders of the Day Nos 4 to 6 postponed on motion by the Hon. Henry Tsang.

HEALTH SERVICES AMENDMENT BILL

Second Reading

The Hon. HENRY TSANG [Parliamentary Secretary] [5.51 p.m.]: I move:

That this bill be now read a second time.

I seek leave to have the second reading speech incorporated in Hansard.

Leave granted.

The Hon. ROBYN PARKER [5.53 p.m.]: It is Ground Hog Day! We are here again trying to fix up this State's failing health system and to deal with the Carr Government's total mismanagement of the system during its 10 years in office. Members of the community. raise with me regularly a long list of concerns about the Carr Government, and the health system is close to the top of that list, along with the appalling train system. The first question on people's lips is: What has the Government done with the money?

Apparently this bill is designed to save money that will then be delivered to front-line health services. I have heard that many times. The Government often promises funds to front-line health services, and every piece of health-related legislation introduced is designed to deliver better outcomes, and more services and resources to front-line health care. This Government has been in power for 10 years and it has enjoyed record State revenue, which has increased over that time by about 80 per cent. In 1995 revenue was $20 billion a year; last financial year it was $40 billion. Thanks to the Federal Government's incredible economic management, the Carr Labor Government has obtained an incredible amount of stamp duty revenue—at least $7 billion more than it anticipated. Despite that, it has slashed 5,000 hospital beds since it came to power.

This bill recognises that mismanagement. It refers to the need to make savings in health care and to redirect that money to the front line. It highlights duplication and inefficiencies in the health system. It amounts to an admission by the Carr Government that its management of the health system is as inefficient as it can be. It has put the health system under incredible stress and strain. The health bureaucracy contains a great deal of duplication and the top-heavy initiatives that are regularly introduced fail to deliver benefits to the front line. That should be the main focus of those providing a health service. The bureaucracy is growing, there is a lack of funding for the provision of beds and health services generally, and doctors and nurses are not being supported. The Government has failed to recruit adequately and to consult local communities so that it can provide health services where they are needed. One does not need to move far out of Sydney to see how difficult the situation has become. Honourable members have talked about Camden and Campbelltown hospitals in the past couple of years, but the community talks about poor health services across the board. The Government's lack of consultation and local focus is clear. It does not seem to be able to examine the situation and to provide good health care in the community. That is the least we can expect of a Government so flush with funds.
This bill amends the Health Services Act and the Public Sector Employment and Management Act. It will allow the Minister to act on the announcement he made earlier this year about the amalgamation of 17 area health services to eight large area health services. That is supposed to result in greater efficiency and savings for the front line. I am keen to see those savings and whether they are allocated to front-line services. I am also keen to see how local communities benefit. The passage of this bill will result in the abolition of area health service boards. A chief executive officer [CEO] who is accountable to the director-general will control the new area health services. Depending on the function of health corporations, they might be governed by a CEO or a board.

This bill also provides for the establishment of area health advisory councils. The Minister will appoint clinicians and community-based consumer representatives, and at least one council member must be Aboriginal. Membership is for four years, and members can serve a maximum of two terms. The advisory councils will have an advisory, consultative and liaison role within the area health service operations, but will have little in the way of decision-making powers. I wonder what their role will be. Why will the council members be appointed by the Minister? The community will be understandably suspicious about the composition of the advisory councils. I do not know how the Government came up with its notion of community consultation. I have heard stories about local members not being aware of meetings convened to discuss the advisory councils. There has been very poor consultation, and that is par for the course with this Government. Its local community consultation is tokenism. If the advisory councils have little power to make decisions, as is evident in this bill, they will be nothing more than window dressing.

The other purpose of the bill is to establish a health executive service under which the new area health service chief executive officers and other service executives will be employed. The bill provides for award contracts—something like the current senior executive service [SES] health—and the current SES health executives will be transferred to that service. The Government has said that this will save $100 million, which will be ploughed back into front-line hospital services. At the same time the Government said that it has a no-forced-redundancy policy. I wonder how, without job losses, those savings targets will be managed and how the resources will be distributed.

For a long time the Opposition has been committed to ensuring that local consultation and local participation in the delivery of health services are of paramount importance. Our long-term policy is to ensure. that local consumers who use the health services in their area have some sort of input into how those services might best meets their needs. Some of these health care services cover large areas so I fail to see how local people could possibly have any input, particularly in areas such as the Hunter-New England Area Health Service—one that I am familiar with—which covers a huge distance and services more than 800,000 people.

With larger police local area commands in large rural geographical areas we have already experienced difficulty with resources being spread to all areas. Local people know the sorts of services they need, and the Government should concentrate on ensuring that all the services are working together and working efficiently. The Government has delivered much the same rhetoric as it did with local council amalgamations. The catchcry has always been that there will be huge savings. We will just have to see how that pans out.

I am aware of concerns expressed by nurses about the new area health services and the new advisory council structure. They are concerned about the level of authority these structures will have and the ability of the Nurses Association and the nursing profession as a whole to have input into New South Wales public hospitals. The other concern that needs to be addressed is whether the Government is using this mechanism to try to cover up just how many senior executives there are in the bureaucracy and how they will be no longer all wrapped into one neat little package but spread over a larger area. Perhaps it looks a bit better for a top-heavy organisation if the senior executives are spread out a bit over a wider area; it may be a good way of masking the actual numbers.

The bill will amend the Act to amalagmate 17 area health services into eight, and I think the greatest concern is the gap between the delivery of services on the one hand and the large area health services on the other, with a head office located at one extreme point of an area. It works quite efficiently for the larger population in the town or city where the new area health service is sited, but those at the extreme ends are, by their geographical distance, likely to suffer from the tyranny of distance.

The Government says that under the new area health councils, the voices of local communities and health planning will be strengthened because they will have direct access to the area chief executive. I am not sure how that works, because on the one hand they say they have little responsibility, yet on the other hand they are supposed to have better access to the area chief executive. At least under the old structure, boards had a statutory role in making decisions. Given that they could have been better structured, there seems to be a lack of consultation, clear communication and contribution with respect to the new proposal. Perhaps if people had been consulted and given time to look at how these health councils might work, and if they. had had an opportunity to provide some input into the structure, we might have some clarification.

Other members will talk about how this legislation affects their areas. I am sure the Hon. Rick Colless will comment on the new proposal for the Hunter-New England area health service, as he lives at one extreme end of that area. It will service 800,000 people and will have 14,500 employees at 39 public health facilities. Although it is not finalised yet, its area will include the Greater Taree, Great Lakes and Gloucester local government areas as well as local government areas in the Hunter and Lake Maquarie. While we have a commitment from the Government that there will not be forced redundancies, on the other hand there have been statements about administrative jobs being slashed from health services across the State. I look forward to some clarification about how the two can work, because I read a newspaper article that suggested that approximately 650 administrative jobs are to be slashed. I am not sure where all of those people might go if there are no forced redundancies and no job losses.

We are told that the merger is going to deliver an extra $100 million to front-line services. We are not told how that will be distributed, and we are not told if it is to be spent on more nurses or on public hospital wards. We do not know where that money will be distributed, much the same as we have no idea where the 2.25 per cent vendors' tax is going to be spent, given that the rationale for that tax, we are told, is that it is to be allocated to front line health care services. There are no guarantees, therefore, that the merger will provide improvements to health systems and savings.

There was widespread concern from New England community leaders about the super health region whose central administration is to be based in Newcastle. People who live in Newcastle would not necessarily be concerned, but anyone who is familiar with the size of that region would agree that it covers quite a distance, and I would hate to see employees of the department spending vast amounts of time on the road travelling the huge distance from one end to the other. The new administrator, Terry Clout has been given a brief by the Minister to oversee the equitable distribution of medical nursing and allied health staff, and to focus on enhancing the recruitment and retention of staff in the New England and lower North Coast sector.

I wish Mr Clout the best of luck. He believes there are significant opportunities to move corporate and administrative services into the twenty-first century. In the Newcastle Herald of 28 July 2004 he indicated that it was easy to give Hunter clients a guarantee that their services would not be diminished and that no-one would lose from the merger. I hope Mr Clout is right. Certainly the Newcastle branch organiser of the Health Services Union, Bob Hull, in the Newcastle Herald on that same day, was sceptical and concerned that the area health service encompasses a larger area, and I feel those concerns are justifiable.

Country communities have more diverse needs and the New England Area Health Service has the highest number of Aboriginal and Torres State islanders and the mortality rate there is substantially higher than in the rest of the State. The needs of people in that area are quite different to the needs of people living in the Newcastle area.

One could be forgiven for thinking that the mergers will make health services less local rather than more local, at a time when community trust in NSW Health services is at its lowest. Few people have confidence that the Government will deliver appropriate services. To increase the size of area health services without providing guarantees of better outcomes does not inspire confidence. Area health service personnel will now have to travel great distances between health care facilities. Numerous general practitioners and visiting medical officers at local hospitals have expressed concern that service levels will not be maintained and improved.

It would be great if we did not have stories of woe from people in local communities but, unfortunately, people complain every day about health mismanagement in this State. In particular, those in outlying areas complain about inefficiencies and lack of communication between different services, hospitals, ambulance services, general practitioners, and other health care professionals. The Government has said the mergers will result in great savings. However, it has not started off on a good footing, because there has been insufficient consultation with key stakeholders, and relevant communities have not been informed of meetings about the mergers.

The Government has merely made a vague attempt to involve communities, and consequently there has been little input from them. The Opposition is extremely concerned about the bill, health care in New South Wales in general, and the Carr Government's inability to manage health services and deliver front-line services and positive outcomes for the people of New South Wales.
The Hon. DON HARWIN [5.15 p.m.]: It was only 18 months ago that we saw a strident defence of the 17 area health services throughout New South Wales from the former Minister for Health, Craig Knowles. However, the worm has turned quite quickly. The Opposition will oppose this hypocritical legislation. The Government has claimed that there will be savings of $100 million, but it is difficult to reconcile that with some of its policies on public sector redundancies. The Government's new approach will certainly lead to a diminution of local input into decisions. The size and shape of country area health services—especially as many of them will incorporate a chunk of metropolitan Sydney—have meant that this change has become embroiled in controversy.

Only yesterday the Opposition moved for papers to be laid upon the table of the House in relation to the Greater Southern Area Health Service. The comments of the honourable member for Monaro and the Minister are a great contradiction. I am sure the Hon. Patricia Forsythe, who moved this commendable motion, will speak further on that. Most of my experiences with the health system have been with the new South Eastern Sydney Illawarra Area Health Service. I have lived in that area all of my life. I was born in Crown Street Hospital, and my only hospitalisation was at the Prince of Wales Hospital. My local hospitals during my life have been, variously, St George Hospital, St Vincent's Hospital, and, currently, Shoalhaven Hospital. Therefore, it is of great interest to me that we have this extraordinary new area health service.

I have had quite a bit to do with drawing maps of regions, electorates and other spatial arrangements over my working life, so it is with some interest that I looked at the area health service boundaries. They are very curious indeed. Inevitably, all sorts of idiosyncrasies will occur with only eight area health services. I am most connected with the area health service running from South Head, Watsons Bay, down to Durras Lake, eight miles north of Batemans Bay, which is particularly curious. On the one hand it includes St Vincent's public hospital, which provides immensely complicated medical procedures and specialist services for communities in the inner east of Sydney. On the other hand, it stretches down to Milton Hospital, which I have visited many times with councillors, the General Manager of the Shoalhaven Group of Hospitals, Monica Taylor, and the honourable member for South Coast. Milton Hospital could not be more different than St Vincent's Hospital.

I am concerned that the formation of the South Eastern Sydney Illawarra Area Health Service will result in a lack of quality and fairness in the allocation of resources because the collection of disparate hospitals and communities will be under the one umbrella. The former Illawarra Area Health Service, which was one of the 17 area health services, illustrated the sorts of problems we will face with the even larger area health services. The Illawarra Area Health Service did not have a Sydney component; it covered the northern suburbs of Wollongong down to Durras Lake, at the lower end of the Shoalhaven. There was an imbalance between population and resource allocation.

In the Illawarra Area Health Service, the city of Shoalhaven had 26 per cent of the population but the funds spent on it did not commensurately reflect its share of the population. Indeed, even the former member for South Coast, a Government member, tried to put the best possible spin on it but he still had to concede—frankly, I wondered about the figures he provided—that we were getting only 22 per cent of the funds. That was despite the fact that it was obvious from the Australian Bureau of Statistics figures that the Shoalhaven was a much older community than the suburbs of Wollongong in the Illawarra region. Our health needs were greater than those in the Illawarra, yet we were missing out on funding.

How much worse will the problem be when we have the South Eastern Sydney Area Health Service stretching from Durras Lake to Watsons Bay? No doubt my colleague the Hon. Rick Colless will talk about the grouping of the Lake Macquarie and Moree local government areas in the new Hunter-New England Area Health Service, which is an extraordinary arrangement. I am sure he will have exactly the same concern that country areas on the periphery of the new area health services will miss out. It will be a repeat of the same old "centre versus periphery" problems: public policy across a whole range of departmental responsibilities, but hospitals like Shoalhaven and Milton in particular suffering under these new arrangements.

In that respect I note that it is proposed to set up a health care advisory council for the region. How on earth can a workable and viable advisory council, with limited numbers, possibly contain all the diverse and—as my colleague the Hon. Patricia Forsythe suggests—competing interests? Certainly, if the South Eastern Sydney Illawarra Health Advisory Council does not have significant representation from the Shoalhaven there will be difficulties in the Shoalhaven. Indeed, if the specialist needs of the inner east, where I lived for many years, are not reflected on the advisory council we will have real troubles, too. If I may be forgiven by my colleagues for saying so, the diversity of those competing interests are even greater in that area than in some other areas. That is part of the Opposition's concern about the Government's approach in this legislation.
The Opposition has made its position crystal clear on a number of occasions. We have raised with the 17 area health services our concern about this legislation. In the past we have presented an alternative approach to the trend towards the centralisation of decision-making and the disfranchisement of local communities. The Liberals and The Nationals believe that clinicians and local communities are well placed to determine what services are needed in their hospitals. Our policy on local input into hospitals at the State election in March 2003 reflected that. For example, in my area of the Shoalhaven I was able to inform residents that a Coalition government would immediately appoint hospital boards to the Shoalhaven and Milton hospitals, and their first task would be to develop revised strategic plans for those hospitals.

As part of developing those plans, the boards would review the adequacy of services and facilities at the two hospitals, and in particular they would report to the Minister for Health on the adequacy of bed numbers. Had we been elected at the 2003 State election, by now there would have been boards for the Shoalhaven and Milton hospitals, and after nominations were advertised in the local media the membership of those boards would have included a minimum of three clinicians, a doctor, a nurse, and an allied health professional. We would also have sought representatives with experience in non-government organisations and in financial, legal and other relevant fields.

As part of the policy we took to the 2003 State election, the boards would have been provided with a budget based on the resource distribution formula. That would have meant that the Shoalhaven, including Milton hospital, would have got an appropriate share of the funds based on population, unlike the approach taken by this Government under the current statutory arrangements. Decisions about what services would be provided and how the funding would be spent would have been made locally in Nowra and Milton-Ulladulla, rather than by bureaucrats elsewhere.

It would come as no surprise that our approach had strong support in the community. It certainly had enormous support in the Shoalhaven, and no doubt that is one of the reasons why the Liberal member for South Coast, Mrs Hancock, was elected and not a Labor member. Indeed, many local people agreed with that sentiment. An article in the Milton-Ulladulla Times of 22 January 2003 stated:

That is exactly the sort of approach country communities were so attracted to at the 2003 State election; they knew instinctively how well it worked in the past. While on the subject of Milton hospital, the need for a board, rather than the approach taken in this legislation, has never been more apparent than it is at the moment. With great fanfare, on 14 March 2003 the Chief Executive Officer of Illawarra Area Health Service announced that there would be an extra five beds in a $6.9 million upgrade of Milton hospital. Work on the upgrade is almost complete, and with the buildings about to be opened, the Government is reneging on its promise to provide five extra beds.

That reminds me of that classic Yes Minister episode in which Minister Hacker exploded when he was told what was happening at St Edward's hospital, the smoothly running hospital with no patients. That is what we are looking at Milton hospital: a brand-new $7 million building that will not have the five beds promised by this Government. The people of New South Wales simply cannot trust the Government with its money when it has such an approach to capital works expenditure and no commitment to provide recurrent funding to keep beds open.
An area health service stretching from Watsons Bay to Durras Lake will result in this nonsense continuing. Decisions on capital works are being made in Sydney, but clearly they cannot be sustained at a local level. An area health service with the sort of geographical spread of the South Eastern Sydney Illawarra Area Health Service inevitably will have problems such as those now developing at Milton hospital.

I call on the Government and the Minister to immediately fund the opening of the five extra beds at Milton hospital. In the lower House we gave the Government the opportunity to incorporate local input into these new arrangements. My colleague the Deputy Leader of the Opposition, the honourable member for Ku-ring-gai, moved amendments in the other House, but those amendments were defeated. It was interesting to see how some of the so-called country Independents voted on those amendments, but more will be said on that later. This bill is fundamentally flawed and we will vote to defeat it. In the event that we are successful, we hope that the Government will bring to the House legislation that meets community concerns that we are supporting here this afternoon.

The Hon. PATRICIA FORSYTHE [5.30 p.m.]: This legislation provides some of the strongest contrasts between the position of the Government and that of the Opposition on a fundamental policy issue: the provision of health services to the people of New South Wales. As I travel around in the community I am often asked about the differences between our philosophical position and that of the Government.

The Hon. Dr Arthur Chesterfield-Evans: Sadly, there is often not much.

The Hon. PATRICIA FORSYTHE: In this case there is a significant difference. The Coalition—the Liberal Party and The Nationals—has a firm view on this issue. Ours is a bottom-up approach rather than a top-down approach. We stand strongly for the rights of local communities to have their voices heard by decision makers rather than have centralised bureaucracies and centralised decision making. The effect of this legislation, which will create a huge area health service to replace the existing 17 area health services, is a retrograde step. The so-called saving of $1 million will turn out to be illusory. What will be created will be an inefficient system that will provide more desks, not more beds.

I have followed in the newspapers the debate about the development of these area health services. In a newspaper article some time ago the honourable member for Monaro, in justifying why the head office of the Greater Southern Area Health Service should be in Queanbeyan, is quoted as saying that it had a better air service than Albury, for example. The only way in which bureaucrats and others will be able to adequately manage the system is to take to the air, because the distances between centres will be so great, and that will lead to inefficient delivery of services. The Greater Southern Area Health Service will cover more than one-third of New South Wales. It will have 43 hospitals and 4 health care facilities, all under the authority of the chief executive officer, who will be created by this legislation.

The Opposition does not believe that makes for an efficient health service. The system is already inefficient, without creating these monoliths that will be the end result of this legislation. Today's Auditor-General's report into health services in New South Wales highlights some of the inefficiencies to which I am referring. With regard to the Southern Area Health Service, which has had significant financial problems throughout the past 12 months in particular, he said at page 202:

• the Service had not nominated a dedicated accounts complaints officer;

• order forms are not printed with the details of accounts complaints officer, the specific telephone number, or that interest may be payable on overdue accounts;

• instances were noted where some creditors were not paid within the established terms;

• the Service did not include payment of account details in its 2002-03 annual report.

All that may seem a fairly minor element of a significant health service, where the focus has to be on patient care, but we have come to understand that under this Government the delivery of health services has been inefficient and, as a consequence, patient care has been found wanting. Another health service in which I have taken a close interest in the past 12 months is the South Western Sydney Area Health Service. In its case the department has noted that the area should not have any creditors, including amounts owing to visiting medical officers, government agencies and contracted patient services over 45 days. The service did not meet this requirement. The department provided one-off assistance of $6 million in 2003 towards payment of these creditors and the service developed a four-year financial plan to address its liquidity issues.
In two area health services we have significant examples of inefficiency and inability to meet the requirements of its legislation or its community. We are now about to impose what I believe will be a totally inefficient service. The Opposition believes in the voice of local communities over a Government that is focused on a strong centralised bureaucracy. I refer in particular to the amalgamation of the Greater Murray Area Health Service with the Southern Area Health Service. It is an area I know something about because my duty province as a Liberal member of the House covers all of that area and then some. My area covers 13 electorates and probably, in geographic terms, covers about half of the State. It is an area of significant and diverse local needs. It is not an area that one can easily drive around.

The amalgamation of those two health service areas will cover about one-third of the State. It will include significant communities from Queanbeyan to Wagga Wagga and Albury, through Griffith and out to Deniliquin, and then to the significant growth communities of coastal New South Wales up to Batemans Bay. It is an extraordinarily significant area yet it is to be managed by one chief executive officer, and we know that the Southern Area Health Service has already had significant debts. We are not confident that expanding the area will do anything to improve patient care. At the end of the day that is what we want.

This morning I had the opportunity to meet a significant delegation from the Batemans Bay community. Batemans Bay is one of the fastest-growing areas in New South Wales. In recent times a multimillion-dollar shopping centre has opened in Batemans Bay, there has been a significant extension to the local registered club and there have been other multimillion-dollar developments. The major shopping centre has taken on 200 staff. Although Batemans Bay may be said to have a core population of about 16,000, the area immediately around Batemans Bay has a population of about 34,000. However, in every holiday period, and in particular in the Christmas school holiday vacation, the area of Batemans Bay absorbs a population well in excess of 100,000 people.

My colleague the honourable member for Bega recognises this fact and the impact on the local hospital. He has met with the community and was instrumental in arranging a significant protest meeting that attracted more than 400 local people who are trying to get this Government to understand that the hospital facilities at Batemans Bay are inadequate to serve the needs of the community at all times, but in particular during the summer.

It seems that there is an agenda that is focused on Moruya hospital, which—while it may be geographically more central to the Eurobodalla Valley—does not reflect where the population lives. So we have the majority of people in a community with a hospital that was built in, I think, 1974, which desperately needs to be upgraded in terms of maternity facilities and emergency facilities, versus a hospital at Moruya that was built in 1932. The community would like to see both hospitals doing well. But the reality is that with the population located in an area that suffers from bushfires, they believe there is a lack of focus in their area.

As an example of the community's needs it was pointed out to me at the meeting this morning that at present the doctor in Batemans Bay hospital—I presume it is a general practitioner but it may be a specialist doctor—who is not able to provide maternity services at Batemans Bay hospital, has on his books 63 pregnant women. That is 63 women who will have to go to Moruya for the delivery of their babies, 63 women who will have to go to Moruya for postnatal care. The community, including one of the women who is pregnant, told me that is totally inadequate. Their greatest fear is that there is an agenda not to give support to Batemans Bay. They doubt that the new CEO and health administrators will take up their concerns and have them appropriately addressed by this new health advisory council.

Batemans Bay has a long list of woes about inadequate funding. We know that Batemans Bay attracts many people in post-retirement years, and a significant number of patients who attend Batemans Bay hospital are elderly. Recently the hospital had to phone Moruya hospital and ask the next visiting doctor to bring more supplies, as it had run out. Today I heard of patients' families having to wash bandages because the hospital lacks the basic facilities to provide surety about hygiene and protection of patients. This is in a community that is growing significantly, a community that will now have just one facility out of 47 across the Greater Southern Area Health Service. It is no wonder that the Opposition opposes the legislation.

Each of my colleagues who speaks in the debate will have a story to tell about problems in local communities—problems that we doubt can be addressed under the enormous, centralised, bureaucratic system to be created by this legislation. I look forward to the tabling in 13 days of documents relating to the Government's decision to locate the head office of the Greater Southern Area Health Service at Queanbeyan. Queanbeyan is an important city, a growing city that would benefit from government services. But there are concerns from doctors in other areas and medical practitioners throughout the regions about why it was decided to locate the head office at Queanbeyan. I look forward to reading the documents.

Wagga Wagga has a very strong tradition in health, particularly in nurse training. Together with Cootamundra, Wagga Wagga has been the core of nurse training in the region and an important teaching facility at the Wagga Wagga hospital. Doctors in the area have expressed concerns about the basis and the wisdom of the decision in relation to Queanbeyan, and there has been debate about it. The honourable member for Monaro claimed that he had got the Minister to locate the head office at Queanbeyan. In other words, there was an implication that it was a political decision. However, when the Hon. Robyn Parker asked the Minister about the reasons for the decision at an estimates committee hearing, he suggested it was not made on political grounds.

Doctors in the Wagga Wagga community have expressed concern about the decision to locate the head office at Queanbeyan rather than Wagga Wagga, which they say would have been more central to areas such as Griffith, Albury and the coast, and the area extends much further west than Griffith. Wagga Wagga would have been more central. Albury is a significant city, and it could well be argued that the head office should be located there if availability of an air service were one of the criteria. Griffith also has access to an air service. The Government's decision to create these significant area health services has not satisfied communities across New South Wales.

There is a feeling that the needs of local hospitals and communities will be ignored in this centralised, bureaucratic, monolithic structure that will be the outcome of the legislation if it is passed tonight. Local communities are speaking up for local needs, as the people of Batemans Bay did in their meetings today with the honourable member for Bega, and with the shadow Minister for Health and the Minister for Health. Perhaps they were a little nonplussed by his unwillingness even to make notes during the meeting about the issues they were concerned about. I have heard nothing from the Government by way of second reading speeches or contributions to the debate in the other House that quieten my concerns about the issues that local communities have raised with me.

The legislation is a step backwards. The Government has said it will be money-saving legislation, and at the same time it has been said that people will not be lost; that positions may go from one area but overall there will not be a general loss of people in the community. I note that Queanbeyan hospital has already had a significant number of people take voluntary redundancies early this year—I think the number was greater than 60. So perhaps it has already had the cuts that the Minister is suggesting he will monitor. The Government has claimed that money will be retained in a region. The regions are now so large that even though money might be retained in the one area it will not be retained in the local communities. There will be a significant shift in resources, but not to the benefit of the community, and not to the benefit of health services. This legislation should be opposed, and I urge the House to oppose it.

Reverend the Hon. Dr GORDON MOYES [5.50 p.m.]: I speak on behalf of the Christian Democratic Party on the Health Services Amendment Bill. The main purpose of this bill is to institute amendments to the Health Services Act 1997. There are many important objects to these amendments, which will have far-reaching ramifications for the provision of health care services in New South Wales. However, the sum of them does not outweigh the liabilities that exist. For example, 650 job losses. Who? Where? It must cause great anxiety for people within NSW Health. I can be sure of one thing: The job losses will not occur in the ranks of administrators and bureaucrats, but in the ranks of front-line nursing services.

The first main amendment is to provide that area health services will be governed by their chief executives. This means that existing area health boards will be abolished. I regret that. I have worked with area health boards for 26 years with great satisfaction. I remember the fine contribution made by community members—volunteers—who could be consulted with great reliability on the needs of their area. I regret the change from community contribution to area health boards and the centralisation of greater power into the hands of chief executives.

The second main initiative is 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. However, no advisory council can hold a chief executive accountable in the same way that a board can. An advisory council, by its nature, can only advise. Chief executives need to be accountable to a board. Under this bill, statutory health corporations may be governed by their chief executives as opposed to being governed by a representative health board. Advisory councils will also be established to give advice with respect to matters affecting the operations of statutory health corporations that are governed by their chief executives. This notion of centralising the power into the hands of a few executives cuts against all the advice of management experts in this field. The Bible states that there is wisdom in the multitude of councillors. This legislation will remove the multitude of councillors and concentrate power into the hand of a few bureaucrats.

The bill will also provide for the establishment of a health executive service similar to the senior executive service under the Public Sector Employment and Management Act. Whenever we see a senior executive service note—or whatever it is called—we should beware. It will simply mean more costs, more executives, more bureaucrats and more fat cats. It does not mean more clinicians, more nurses, more domestics, more cleaners, more Aboriginal health workers, more physiotherapists or any other allied health professional.

I will indicate some of the most salient reforms proposed by this bill. I do not favour all of the initiatives introduced in the bill. The Minister announced in his second reading speech that the present 17 area health services will be amalgamated into 8 larger health service areas. The Minister's intention is that the area health services will be formed on 1 January 2005. In relation to current area health service boundaries, the Minister pointed out that:

I am sure there are better ways of improving the health service structure and reducing administrative duplication and inefficiencies than abolishing the area health boards. The Minister further stated:

I wonder where that money will come from. It seems to be a gloss. It is all well and good to argue for cost efficiency, but the question at the forefront of my mind is whether the community will actually benefit from the proposed changes. Will the delivery of health services be improved upon amalgamation? The Council of Social Service of New South Wales has raised some valid points arguing against the proposed amalgamations. I side with its point of view. Although not directly footed by the Government, there will be increased costs in time and money that will be borne by NSW Health employees and health practitioners having to travel extended distances. Importantly, the council has asked itself how health will be improved. The council has said:

It has been proposed that the amalgamations will lead to greater access to health practitioners, yet how this will happen has not been addressed. For example applications for a public dental position was advertised in Sutherland. Five applicants were interviewed and those that were not successful in Sutherland were informed of a vacancy in Wollongong (which included additional loadings). No one would take the position because of the greater distance to travel. Merging South Sydney and the Illawarra will not change this.

The council questions whether accountability will be improved within the larger areas resulting from the mergers. Larger populations involve greater responsibility and, thus, increased accountability. There is a world of difference between New England and Newcastle. How can there be equitable resource allocation over such a vast area covering so many facilities and so many communities? It is now impossible to find out what has happened to spending on programs constituting only a few million dollars. It will be even more difficult to trace where money is flowing with larger budgets.

The council has also questioned whether community representation can be just and equitable with such large areas and the varied communities within them. A previous speaker asked how we can achieve equitable distribution of funds when there are 47 facilities in one region. The question posited is how the communities in the Greater West can be truly represented on an advisory council when there is a five-hour journey to the head office from the perimeter of the area? Further, if the North Sydney and Central Coast areas were merged, the resulting configuration would be a wealthy community in North Sydney alongside ageing and more disadvantaged communities such as Wyong and Warnervale. Unfortunately, it is difficult to see how this area will be represented effectively when there are totally different community needs. The Government obviously has rushed into this measure. It should have provided examples of how efficiency and accountability will be achieved with more centralised and more authoritarian administration. I believe it is absolutely impossible to show that more centralised and authoritarian administration will provide greater efficiency and more accountability.

The bill proposes to abolish area health boards, vesting their current power in area health chief executive officers. Unfortunately, the main problem with this initiative is that a very real risk of reduced accountability and transparency will emerge. Giving one person the responsibility currently held by the area health boards will allow that person extremely wide discretion. In my view, two heads are always better than one, and 12 are better than one! That is because varied viewpoints are sometimes necessary in order to effectively tackle any issue and to truly represent the many constituencies of an area. The Council of Social Service of New South Wales has also pointed out that:

The proposed abolition of the Boards has the potential to make Area Health Services even less accountable and transparent. An Area Health Service Performance Agreement would at least be able to be a public document available for public scrutiny. However, a CEO performance agreement as with any organisation, would be a private document between the CEO and their Employer...

The bill also sets up area health advisory councils, which will advise area health service chief executive officers [CEOs] on issues that concern them. This proposal has so many flaws that it beggars belief. The report titled "A Clear Voice for Clinicians and the Community" provided by the Clinical and Community Advisory Group is a very suspicious document. It is a gloss production designed to paper over failure and fundamental changes to local accountability for the health system. These councils have a purely advisory role, which means that the CEOs do not have accountability to the representatives of the community to whom they are providing services. That is totally contrary to all modern management practice. In my opinion, advisory councils should be given more powers to enable them to oversee the performance of the subject area health service and CEO.

Also, as suggested by the Council for Social Services of New South Wales, it would be useful if the legislation reflected the recommendations of the mix of members of the area health advisory councils. I was disappointed to read that there would be 13 ministerial appointees to the area health advisory councils. There are already too many ministerial appointees. The council suggested also that it would be useful if the legislation provided some broad guidance on how the members of area health advisory councils will be chosen. There should be an open representative process as opposed to a closed selection process with ministerial appointments.

NSW Health is suffering from a lack of clear vision. It is suffering from a decreased provision of front-line services and an increased number of administrative desks rather than beds. The Christian Democratic Party despairs of the Government's answer to increased demands for services by reducing the health service area boards to advisory councils.

The Hon. Dr ARTHUR CHESTERFIELD-EVANS [6.00 p.m.]: I am concerned about this bill, which does not have a clear vision for New South Wales. I wonder if the flurry of bills is a response to political pressure so that the Government is seen to be doing something. I must confess I have no problem with the view that we need more people on the ground doing things. I worked for almost two years in the British National Health Service in the United Kingdom. In that service clinicians and the administrators were worlds apart. Administrators had taken over even some of the smaller, uneconomic hospitals. One such hospital had been trying to get a new car park for years, and when the administrators were brought in the area was soon paved over. Clinicians had virtually nothing to do with the administration; they certainly had no faith that the administrators would come up with the right resources or do the right thing. That demoralisation resulted in much-reduced patient care.

I recall I was working in a 1,500-bed hospital three nights in five and three weekends in five with another young doctor. At one stage he took three weeks holiday and two weeks study leave, keeping him away from work for five weeks. I was then required to be the orthopaedic registrar first on-call for any accident victim that came to this 1,500-bed hospital in the north of England in the middle of winter. I recall saying that if I was to be on call 24 hours a day for five weeks straight, I would be in a terrible situation. The job could not be done, and I recall going to complain to the administration personnel manager, whose name, interestingly, was Mr Moran. There is no prize for guessing what his nickname was. He said, "We have terrible trouble getting casual staff." I said, "It is even harder if you don't ask or advertise", to which he replied, "But it is terribly hard." He made no effort to engage anyone, and I was on call 24 hours a day for five weeks straight. I did not leave the hospital grounds in all that time.

The point I am making is that this is what happens when administration gets out of touch, and I believe that trend is developing in New South Wales. The question then is: Is this bill the way to reverse that trend? I doubt it. I understand that Ernst and Young have been asked to compile a report on how to cut the number of bureaucrats and increase the number of people involved in direct patient care. It is worrying that this report has not yet been released and this bill is going through with its parameters set so that there will be eight area health services and no forced redundancies. How is it possible for a consultant to make a determination about the number of bureaucrats and service delivery when the parameters of management structure and redundancy are set?
The growth of a health executive service is also a worry. I know that anecdotes should not drive the whole system but I can remember what the situation was when I worked at Sydney Water. The boss at one time was incompetent earning $56,000; when the senior executive service was introduced he was equally incompetent earning $88,000; and he went on to be even more incompetent earning $150,000. It was the same chap earning hugely increased salaries. I am not sure that Sydney Water was well served with a senior executive service.

Area health boards are to be abolished. While travelling around New South Wales with General Purpose Standing Committee No. 2 some years ago I recall people being very distressed about the abolition of local hospital boards, which they believed could relate to local situations. I remember when I was a child my father coming home from meetings of the hospital board in Wollongong—he became the senior surgeon there, but I am not sure that he held that position at the time I am recalling—saying that local businesses were represented on the hospital board and that their expertise was most welcome when matters such as the hospital garbage contract was discussed.

The hospital board was intelligently critical of the CEO and the decisions that were made, and, however long and boring the meetings might have been, there was a creative tension between the board and the CEO. In a sense, the board members were more on the ground than the CEO was, and the CEO was kept on his toes. If the area health boards, which replaced the individual hospital boards, are abolished, advisory councils will be appointed by the Minister, and this will give rise to cronyism or, if not cronyism, the appointment of people known to the Minister for not biting the hand that is feeding them.

The nurses at Campbelltown hospital were unhappy with what was happening. They believed that the service that was being delivered was not in the interests of the patients but they felt that there was no-one they could go to who would stand up to management for them. If there were an area health board that was not appointed by the Government and that did have its roots in the local community, clearly that would be the body to whom one could complain that the service being delivered by a hospital is not good enough. Problems with the lack of resources and with certain personnel must be looked at from outside taking into account the interests of patients. Clearly, if the only alternative to a hierarchically structured system that reports to the Minister directly is an advisory council that owes its existence to the Minister, the alternative is unlikely to respond intelligently to outside forces and to be a neutral feedback loop, in a sense fighting for the community's interest.

The alternative would be to centralise the system in Sydney. That may sound ridiculous to some, but matters such as distance, specialised techniques, centres of excellence that perform operations not available in smaller hospitals, additional funding, the Isolated Patients Transport and Accommodation Assistance Scheme can be discussed and considered in any resource distribution formula that is arrived at.

It makes reasonable sense to run the greater western area from Dubbo. I understand the area is similar in size to Germany, in the sense that it takes one five hours to drive across it. With regard to the Hunter-New England service, which is based in Newcastle, one wonders whether it should be managed from Sydney, given the flight paths of the planes, which all come to Sydney, as opposed to the road network. In the greater southern area all the air services either go to Melbourne or to Sydney. I do not think Queanbeyan is in any way linked by air services or is even on the most direct road route.

The Hon. Patricia Forsythe: It is not on the road route, but Canberra airport is quite significant.

The Hon. Dr ARTHUR CHESTERFIELD-EVANS: I am not sure how many flights go from Canberra to Wagga Wagga. Are there many?

The Hon. Patricia Forsythe: That is the point. They do not.

The Hon. Dr ARTHUR CHESTERFIELD-EVANS: Air transport is basically to Sydney. People covered by the Greater Southern Area Health Service are not happy about services being located in Queanbeyan. Having a bureaucracy in Queanbeyan separate from the Sydney bureaucracy will result in people in those areas being two rungs further down the administrative ladder. Those services will move from Ulladulla to Wollongong, and even though Wollongong is closer than Sydney, one wonders whether the added administrative burden will improve services. If there were only one area health service in Sydney, resource distribution formulas would be more equitable between the various existing area health services throughout the State.

It may seem radical to centralise health services, but if the hubs of these eight area health services are so far from the areas they serve, it may be better for the State to be served by only one. Certainly, that possibility should be considered. Port Macquarie is a long way from Lismore yet the North Coast area will be managed from Lismore. Liverpool and Campbelltown, in terms of the Sydney metropolitan area, are quite a distance apart. Wyong, a relatively poor area, is a long way from North Sydney, and it is likely that Royal North Shore Hospital, which has considerable problems, will dominate the scene—although I understand North Sydney and the Central Coast will be managed from Gosford. However, the mix of Sydney's North Shore with Wyong is interesting.

The Council of Social Service of New South Wales [NCOSS] is concerned about the representation of communities in the greater west, as mentioned by my colleague Reverend the Hon. Dr Gordon Moyes. We have heard about huge savings of the order of $100 million resulting from the mergers, but I wonder whether those savings will be realised, particularly if a health executive service is to be created, which usually means bigger salaries for people doing the same jobs. NCOSS is also concerned that the mergers have been implemented from a clinical point of view rather than from the point of view of public health measures, which determine health populations.

The Australian Institute of Health and Welfare, which reported on Australia's health in 1990, produced a graph noting the number of doctors and the neonatal death rate in a large number of countries. It showed that basically neonatal death rates and life expectancy bear no relationship to the number of doctors in any given population. The suggestion was offered in respect of a country's health quality that life expectancy and neonatal death rates increase with mean per capita income up to a level of about $US5,000 per head of population. After that figure, life expectancy and neonatal death rates—the two indices for the health of a population—are more related to the equality of distribution of wealth than to the absolute mean income of a population.

That illustrates the point that if we are talking about health rather than "illness treatment", which has appropriated the word "health" in our parlance, we are talking about the "paying for illness system". Health is being ignored at the public health level. I am not sure that the reforms in the bill deal with the key issue raised by NCOSS relating to the efficiency of health promotion across the existing 17 levels. Statewide we should concentrate on areas with poor health benchmarks. Whether that will happen with these fewer empires is another question. It might be argued that the area health service boards will be too large for local contact and too small for the big picture. They are neither one thing nor the other. The Government wanted to be seen to do something, so it introduced this bill.

NCOSS considers accountability of area health services to be a key issue. I am not convinced that the bill is even necessary or that it is timely. I acknowledge the Minister's remarks that Wendy McCarthy and Ian Sinclair, as part of a clinical advisory group, have consulted some people. However, I am not sure that the bill is the answer to the problem. The matter needs further consideration, and I am not sure that I will support the bill.

The Hon. RICK COLLESS [6.16 p.m.]: I place on the public record the disquiet expressed by communities in the Northern Tablelands that have missed out on having their concerns aired in the Legislative Assembly on a number of bills during this session of Parliament. The member for Northern Tablelands did not contribute to debate on this bill; the Health Legislation Amendment (Complaints) Bill, and cognate bills; the Health Legislation Further Amendment Bill, which was passed by the Parliament yesterday; the Registered Clubs Amendment Bill; the Threatened Species Legislation Amendment Bill; the Gene Technology (GM Crop Moratorium) Amendment Bill; and the Smoke-free Environment Amendment Bill. In fact, the member for Northern Tablelands has not made a contribution to the second reading debate on any bill since 1 June 2004, and has only made three contributions this calendar year.

The Hon. Charlie Lynn: What does he do?

The Hon. RICK COLLESS: That is a very good question. The people of Northern Tablelands are not having their voices heard in the Legislative Assembly on issues important to them. The people of Northern Tablelands and New England are very concerned about this bill, as was demonstrated by the huge protest rally recently held in Tamworth that was attended by 800 people from all over the region. There was enormous concern in the north-west when the New England Area Health Service was established many years ago. This concern focused on the centralisation of power and decision making, with smaller communities such as Tenterfield, Glen Innes and Inverell becoming subservient to the larger areas of Tamworth and Armidale.

The bill proposes to abolish the 17 area health service boards and create eight much larger and potentially unmanageable regions. The concerns expressed previously by people of Northern Tablelands are now magnified many times. The original health service will be expanded to include the current New England and the Newcastle area health services, administratively an area from Wallangarra, which is on the Queensland border north of Tenterfield, south to Lake Macquarie, which is south of Newcastle, and west to places like Goodooga and Collarenebri, which are west of Moree. This will create an unmanageable monster that will not guarantee the provision of improved medical services for the people of Northern Tablelands and the small communities within that proposed area.

The Inverell community has expressed concern about a loss of health jobs, both clinically and administratively, as a result of the amalgamation in Inverell. The Minister's response was the offer for Inverell to host the payroll division of the new health service. Although that offer is supported from the perspective of maintaining administrative jobs in Inverell, it will do absolutely nothing to guarantee the provision of clinical services at Inverell Hospital and other small hospitals such as those at Tenterfield and Glen Innes. Why has the honourable member for Northern Tablelands not taken up this issue? Why did he not raise this issue on behalf of the people of Inverell during the second reading debate on the bill in the other place? Is it because he is totally parochially focused on his pet project, which is the reconstruction of Armidale hospital, at the expense of all other health facilities within his electorate?

Staff members at Inverell hospital have pleaded with the local council to do something to guarantee that clinical services will be improved or at the very least maintained at the hospital. The people of the Northern Tablelands, including medical staff, are crying out to have their voices heard about this nonsensical amalgamation. Greater centralisation will result in no local input into the big decisions and a reduction in the provision of local medical services. Nurses are also concerned that the larger area health service will affect the responsibility and authority currently enjoyed by the nursing profession, albeit in a declining form at present.

Country communities have long been concerned about nurse recruitment in rural areas, particularly in smaller hospitals. Nursing staff in many country hospitals have an average age that is only a couple of years below the accepted retirement age for nurses. This bill will do nothing to stimulate the movement of nurse trainees into the industry, and the current model of sending nurses to universities for initial training means that few nurses are encouraged to return to their home towns in the country, such as Inverell, Bingara, Barraba, Warialda and Wollar, which have small hospitals and simply cannot get nurses. If nurses were to receive their training in country hospitals while making part-time or external arrangements for their academic training, a huge pool of potential nurses would suddenly appear in smaller country towns.

There is also a developing problem with physiotherapists. They are generally located in larger country hospitals, but hospitals are now only employing—believe it or not—first year graduates and are not renewing their contracts in year two. The only reason for enforcing such a nonsensical policy must be to save money—money that the area health service will be able to transfer to bureaucratic expenses and the unmanageable, burgeoning administrative system that will develop as a result of this bill. The end result of the physiotherapist situation is that there will be new positions for year one physiotherapy graduates but no opportunity for progression to year two within the public hospital system.

Year two graduates will be required to find positions in the private health system, with the public system reneging on its responsibility to complete the training of newly graduated physiotherapists. I have outlined some of the concerns of the people of the Northern Tablelands and the communities that rely on the New England Area Health Service for the provision of health and medical services. The people of the Northern Tablelands and officers of the New England Area Health Service wish to see a return to a more decentralised health administration model, not a more centralised model. As such, I am opposed to the abolition of the 17 area health services and the creation of eight larger boards, which will prove to be totally unmanageable. Therefore, I oppose this bill.

Ms SYLVIA HALE [6.23 p.m.]: The Greens are opposed to the amalgamation of 17 area health services to form eight, which will result in the administrative centres that make decisions about health service delivery being more remote and removed from the communities they are supposed to serve. Some of the proposed new areas will be enormous. The eastern suburbs of Sydney will be in the same area as Nowra; the North Shore will be lumped in with the Central Coast; and the Greater Murray region will stretch from Bega to Hay—an area the size of Victoria. The Macquarie Area Health Service will be merged into an area more than three times its present size, and the new greater western area will stretch from Dubbo to the Queensland, Victorian and South Australian borders. Obviously this will result in fewer services for people in the bush.

The needs of areas such as Nowra and the Central Coast, which have some of the most disadvantaged communities in the State, are different to those of the affluent North Shore or eastern suburbs. One does not have to be Einstein to work out that the needs of regional centres will be overshadowed by city issues, with small country towns and large urban centres being serviced by the same area service. In the case of the Greater Murray area, the distances are so great that the administrators will find it almost impossible to get to all parts of the new area with any regularity. Recently I travelled to Dubbo. All the residents I met there were unanimous in their view that amalgamations of this scale were universally bad for the bush.

The Hon. Michael Gallacher: I hope you got some media while you were out there—for the Labor candidate!

Ms SYLVIA HALE: I was there supporting the Greens candidate. He was the Greens candidate at the Federal election, and he is the Greens candidate in the Dubbo by-election. Unlike the Labor Party, we are standing a candidate in the Dubbo by-election. Be that as it may, we share the concerns of the bush about these area health services and the disadvantages they will produce. One thing that strikes me is that there are elements of this legislation that are common to elements in other legislation that has been passed by, and is about to come before, this House. That is the way it seems that the Government is devising mechanisms to prevent boards from being accountable. They are now all advisory boards. This is of major concern for people in the bush. Interestingly, the following is the very first concern mentioned in the report of the Clinical and Community Advisory Group entitled "A clear voice for clinicians and the community", which came out in October 2004:

It seems that the Government has gone through the process; it has paid lip service to consultation. The group went around the State and supposedly spoke with 2,300 people. The first concern is the lack of accountability and the remoteness of these advisory boards. There is also concern about the manner of the consultation. The report stated further:

Anyone who was involved in the debate about local council amalgamations will know that those same complaints were made about the so-called consultation that preceded the amalgamation of many rural councils. So the Government obviously has a technique in this regard. It says, "We have met and talked to you", but it avoids and ignores any feelings expressed at such meetings and then ploughs ahead and does what it wishes. The Government wants to put in place boards consisting of government appointees that are in no way accountable to the communities they are supposed to represent. A second issue was raised in the report. It is not addressed in this bill, but I think it is reminiscent of all the concerns raised in relation to council amalgamations. Concern was expressed about a potential reduction in particular positions within the new area health services, including staff working with local Aboriginal communities. Rural residents were anxious also about the implications of the reforms for local employment opportunities and local businesses, including the sourcing of contracts and supplies.

Those concerns are identical to those raised during the local government amalgamation process. One of the justifications the Government makes for this rearrangement is the repeated savings it will achieve. As the Hon. Dr Arthur Chesterfield-Evans said, there has been no indication as to how those cost savings will be made, but presumably the health executive service will presumably wish to be remunerated at the executive service level. So, we may see a blow-out of salaries at the top of the tree and a loss of jobs, services, and on-ground people and staff at the bottom level. I fear this is the Government's recipe for systems reform.

This is not the first occasion on which the Government has resorted to centralisation as a means of appearing to address problems. It did it with councils and it has also been done with the TAFE system. If you have a problem, you give the appearance of addressing it by concentrating power and when, after a few years, that does not work because it does not really address the fundamental problem at the heart of the matter, you decentralise again. You get this yo-yo effect which serves no-one but the Government. It creates a smoke and mirrors effect that something is being done.

There is considerable concern within the community. The Council of Social Service of New South Wales and other bodies are certainly greatly concerned about the lack of transparency. The Greens will move an amendment to the bill to endeavour to ensure that the advisory boards and the system are accountable to the communities they represent. The amendment will require the area health services to produce annual reports, the contents of which will be judged against a series of performance indicators. As I have said, we are greatly concerned. If these boards are to be set up, they should be representative of the community, but their areas are so large that it is impossible for them to be representative. The clinicians and communities report says:

It is impossible for anyone to have the range of skills required to adequately reflect the diverse interests of so large an area. As I say, the Greens do not support the bill, and we will seek to amend it.

[The Deputy-President (The Hon. Kayee Griffin) left the chair at 6.34 p.m. The House resumed at 8.15. p.m.]

The Hon. JON JENKINS [8.15 p.m.]: The reforms to the health system are trying to achieve a balance. I initially told the Government that I would support the bill but after listening to Reverend the Hon. Dr Gordon Moyes I have some reservations, which I have informed the Government of. The question is really whether the Government has the right balance between a top-heavy bureaucratic structure and a bottom-heavy unresponsive structure. I have told the Government that if it appoints some of its party faithful or political mates there will be no improvement, there will just been more of the same. It is obvious that the current system has faults and is not working well. That is why the people on the advisory committee employed to advise on the health system have reported as they have.

It might be prudent to remind the Government of what its colleague Peter Beattie said recently in the Queensland Parliament. He reminded people that just a short time ago the Queensland people overwhelmingly elected a State Labor Government, but that just a few months later they overwhelmingly elected a Liberal-Nationals Government. The same people voted Labor but within a few months voted Liberal. Peter Beattie concluded from this—I agree with him, as I have said before in the House—that the face of politics is changing. People do not slavishly vote for a particular party any more. People who have previously voted Labor all their lives do not necessarily vote Labor any more; and the same applies with people who previously voted for the Liberals. People are looking for good governance and good policy.

I encourage the Labor members to listen to the Labor Premier of Queensland. Obviously they will not listen to me—I am not terribly important to their plans—but they should listen to a Labor Premier who is telling them the same thing: that people are looking for good governance and good policies. My main concerns are for the regional areas; they are the areas that will lose out. They already have poor services, or no services in many cases. They have poor representation. I am interested to see whether the Opposition has some useful suggestions for amendments in this regard. Instead of just criticising, they should come up with something decent to try to fix the situation.

The Hon. Don Harwin: We already have, in the lower House.

The Hon. JON JENKINS: I acknowledge the interjection, because I have experience of the old days with hospital boards. I understand the reasons they would like to go back to the old system. But the old system had serious problems as well. Hospital boards became personal fiefdoms. They were very unresponsive to the impetus for change. So I do not necessarily agree that just going back to the old system would work. I will take some advice on that. I truly hope the health executive service, in whichever form it comes, does not simply become another retirement desk for party hacks. If the Government puts good people on the advisory committees, the local boards—whatever the Government wants to call them—it will get good advice and a good health system.

The Hon. JOHN DELLA BOSCA (Special Minister of State, Minister for Commerce, Minister for Industrial Relations, Assistant Treasurer, and Minister for the Central Coast) [8.22 p.m.], in reply: I thank all members of the House for their contributions to the debate, during which a number of important issues were canvassed. We should focus on the fact that this is an issue of great concern to the community. The Hon. Jon Jenkins made the point that the community has certain expectations about the provision of basic services, including health services. The community response to public health services is based on a requirement for excellence and identification with public need rather than, as he perhaps rather inelegantly put it, the appointment of political favourites and those who owe their appointment to some regional or local trade-off rather than to a commitment to community service and a capacity to provide feedback to the Government and clinical staff about the needs of the community.

I can assure him and the House that the Minister and the Government have no intention of returning to the kind of world he suggested. Opposition members and some other honourable members have suggested that this bill establishes a new area health service structure. The bill does not provide for the establishment of the eight new, larger and more efficient area health services that commence operation on 1 January 2005, and it does not provide for shared corporate service reform. Enabling legislation for those reforms, the Health Legislation Further Amendment Bill, was passed by this House today, so the changes required to ensure that the new area health service boundaries are in place on 1 January 2005 have already been made.

Area health service boundaries are established by way of a Governor's order. The Government moved to establish the new boundaries on 27 July 2004, when the Planning Better Health reforms were first announced. The 17 area health boards were immediately removed and replaced with eight administrators who have been responsible for managing the transition to the new area structure. It became clear in October that the administrators would be able to achieve the 1 January commencement date for the new boundaries, and, accordingly, the Governor made the Health Services (Amalgamation of Area Health Services) Order 2004, which was gazetted on 22 October. The order provides for the amalgamation of the existing 17 areas into the eight new areas on 1 January.

The current boundaries no longer reflect New South Wales' population distribution, make-up and growth, health work force distribution, and patterns of clinical referrals and patient flows. They do not take into account improvements in communication, transport and travel times, and impact on the way area health services can be delivered. The new, reduced administrative duplication and inefficiencies and the improved consistency in the way health services are delivered, encourage the building of better clinical networks, enhance academic and teaching linkages, break down barriers that currently limit the fairer distribution of the health work force, and facilitate much-needed corporate and business support services reform.

There have also been comments that the Government's reforms will result in a loss of hospital services, particularly in rural communities, and that the Government will not be able to manage a reduction in the health administrative work force to realise the $100 million savings the area reforms and the shared corporate services reforms will achieve. All the Planning Better Health reforms, including those dealt with in this bill, are designed to improve area health services across New South Wales.

In developing the Planning Better Health reforms, the Government has been particularly mindful of the needs of smaller rural communities. The reforms seek to streamline area health administrations and the health executive, not the clinical services provided from local hospitals. Local hospitals will continue to provide services and have their own management structures in the area framework, as is currently the case. The amendments moved by the Opposition in another place will cost taxpayers an estimated $18 million a year in administration. That is $18 million that could be better used to provide 813 total knee replacements, 915 total hip replacements, 9,264 cataract extractions, 820 cochlear implants, 997 heart bypasses, or 4,668 baby deliveries. It could employ 320 nurses or 120 staff specialists.

The new area health boundaries will reduce administrative duplication and inefficiencies and improve consistency in the way area health services are delivered. Where efficiency savings are made in rural areas, the savings will be used to employ additional front-line clinical staff and provide other clinical services in the area. The large areas will also open up a range of new services closer to patients' homes. For example, the administrator of the mid North Coast and Northern Rivers area health services has advised that the establishment of the new North Coast Area Health Service will enable a broader range of people to access the multidisciplinary pain management clinic opened at Lismore Base Hospital in February 2003. Some patients who live closer to Lismore than Port Macquarie have previously had to travel to Port Macquarie for gallbladder and pancreatic health care services. They will now be able to access those services at Lismore.

The Hunter Area Health Service has identified strengths in providing mental health services and the statewide Child and Adolescent Mental Health Care Network, which is managed by the Hunter Area Health Service. It provides and co-ordinates inpatient and community care services for children and adolescents across the State. The amalgamation of the Hunter and New England area health services will support more equitable access to mental health beds in the New England area.

Cross-facility access to patient records will also improve patient-care flows. The reforms will encourage greater clinical networking and enhance academic and teaching links. For example, the New England Area Health Service has no tertiary referral hospitals and New England clinicians will now benefit from having links to the John Hunter and Mater tertiary hospitals. More doctors will seek to work in the area so they can benefit from links with those tertiary hospitals. The reforms will also help break down some of the barriers that limit the fairer distribution of the health work force, and health area services will be better able to encourage clinicians from well-served parts of the region to take up positions where the need is greatest.
In relation to job losses arising from the restructure, the Carr Government and Country Labor can be justifiably proud of how they have created additional public sector jobs in country New South Wales. Since 1995 the Government has created approximately 2,890 public sector jobs in rural and regional New South Wales and has relocated approximately 1,940 more. By the end of 2005 about 2,500 government jobs will have been relocated to regional New South Wales, and approximately 3,400 more will have been created. Examples include a range of services across a range of departments. The area restructure will result in the loss of some administrative and management positions, although the greatest losses are anticipated to occur in the larger metropolitan area health services. However, the savings that are realised will be able to support new clinical jobs.

The Government has been completely up-front in acknowledging that some support positions will be lost and understands that job losses are particularly noticed in smaller rural communities. The Government's Shared Corporate Services Management Program will also result in some administrative positions being shed, although savings will also be achieved through improved economies of scale and purchasing arrangements. There is a popular misconception, promoted by some irresponsible members of the Opposition, that shared service reform means country jobs will all be centralised in Sydney. This is not the case. One of the guiding principles for the shared corporate services strategy is that regional and rural employment and economic development opportunities will be considered in developing the shared services model.

On the one hand Mr O'Farrell has criticised the Government's Planning Better Health reforms for resulting in the reduction of administrative jobs. On the other hand, he has criticised the Government's policy of no forced redundancies. Of course, the Opposition does not want to be seen to be supporting reforms that will result in any job losses, however necessary, but when job losses do occur the Opposition wants us to impose forced redundancies on people. The Government believes it has a duty to those officers who will lose their positions as a result of the reforms.

NSW Health is the largest employer in New South Wales and therefore has a comparatively high number of staff lost through attrition each year. Some of the impacts of the reforms can be absorbed through not refilling positions that have been lost through natural attrition. NSW Health also finds it easier to redeploy removed officers in other useful work, given its size. Where attrition and redeployment are not preferred options, NSW Health may provide a voluntary redundancy program, consistent with the Government's policy of no forced redundancies.

The Government estimates that around 625 management and administrative positions in area health services will be deleted as a result of the restructure of area boundaries. These calculations were made with reference to a comparison of clinical to administrative staff employment ratios, with it being acknowledged that rural areas need a greater proportion of administrative staff, given their size and the variety of communities served. The precise number, type and location of positions to be deleted in every separate area will be able to be accurately determined after the new area organisational structures are finalised, which is currently taking place in consultation with the Labor Council and health service unions.

The various health service audits all require the Government to consult on significant workplace changes. That consultation process will run its course before final decisions are made on job losses in particular communities. The Planning Better Health reforms will, over time, free up $100 million a year that is currently spent on health administration. The savings will be reinvested in front-line clinical services in the areas that deliver them. The area health service boundary changes are expected to result in savings of $40 million a year when new area establishments are in place. The abolition of area health service boards is expected to save around $2 million a year after area health advisory councils are established. The remainder of the savings will be delivered by NSW Health's Shared Corporate Services Program.

There is a long history of reforming corporate and business services across the New South Wales public health system. In the first half of the 1980s each hospital was essentially responsible for its own corporate and business support services. The inefficiencies of this system have been progressively reduced by both Labor and Coalition governments with the introduction of area health services in metropolitan areas, the subsequent reduction in their number, the introduction of district boards in rural areas and then their replacement by rural area health services.

NSW Health has a clear track record of successful corporate and business support service reform and in realising the expected savings and benefits. The $100 million per annum in savings that will be released over time as a result of shared corporate service and area health service boundary reforms is achievable and the Government has committed to an independent audit process to ensure that savings targets are met. The proposed abolition of area health boards will enhance accountability in health service management, not detract from it as some honourable members have suggested.

The bill provides that the responsibility for area health service governance lies with the chief executive and their management team, subject to the direction and control of the Director-General of the Department of Health who is, in turn, accountable to the Minister for Health. Area health advisory councils are, as the name would suggest, advisory, not governing bodies. Working with local health participation groups they will be far more effective than boards in bringing the views of the community and clinicians to the attention of the area health service executive, because that is their specific function.

The Planning Better Health reforms, including the abolition of boards, are all geared towards improving accountability in health administration. On 17 April 2004 the Sydney Morning Herald reported the Leader of the Opposition's commitment to the abolition of area health boards because they reduced ministerial accountability. Whilst the Leader of the Opposition has retreated from his previous sensible position, the bill provides for a clear line of accountability from the chief executive, to the director-general, to the Minister for Health. Of course, area chief executives cannot manage an area health service by themselves and the Government's reforms do not provide for that.

While some differences in management structures are needed to address local variations, there needs to be far greater consistency in health service management. The inconsistencies make it harder for staff moving across areas to adapt to their new work and harder for the department and Government to monitor the activities of health services. The new area health management structures will improve area health service accountability. There are a number of board subcommittees and other bodies that have assisted in running area health services, such as the finance and budget committee, audit committee, ethics committee, clinical quality committee and medical staff council. All of these bodies have continued to operate since the boards were removed and administrators appointed. These committees have continued to work well in supporting the administrators, and we need to ensure that their valuable work continues.

Proposed sections 29A and 52E specifically recognised the powers of chief executives of health services to establish such committees. Proposed sections 39 (1) (g) and 60 (1) (h) extend the by-law making powers to include matters relating to area committees and councils with the director-general or, in the case of board-governed statutory health corporations, the Minister, able to establish model by-laws as to how such committees and councils will operate. This bill and the associated reforms to health administration provide for more efficiently managed and accountable health services. The Coalition deserves some credit for its approach to modernising health service administration in the late 1980s and 1990s. It was the Coalition, in 1988, that reduced the number of area health services in metropolitan areas from 23 to 10. It was the Coalition, in 1993, that abolished 111 public hospital boards in rural areas, moving towards a more co-ordinated district system of administration which mirrored arrangements for metropolitan area health services.

In 1996 the Coalition supported the Government's extension of the area health service system to non-metropolitan New South Wales, establishing the current 17 area health services and dispensing with district boards. The Government's reforms are a natural extension of those earlier important reforms, supported by both sides of this Chamber. In January 2003 the Opposition about-faced and announced that it would re-establish 90 hospital and district boards. In April 2004 the Leader of the Opposition again turned 180 degrees and stated that he would abolish the 17 area health boards as boards blurred the lines of accountability in health administration. Now the Opposition wants to retreat from its previous sensible position and again reintroduce hospital and district boards.

I admire the Coalition and the speakers during this debate for their flexibility on this issue. It must be incredibly difficult to backflip and turn back the clock at the same time. I would like to quote from an exchange between the Hon. Melinda Pavey and the ABC Mid North Coast's Graham Robinson, which illustrates some of the difficulties with the Opposition's policy. Mr Robinson said:

The Hon. John Ryan: She hasn't even contributed to the debate.

The Hon. JOHN DELLA BOSCA: She is here in spirit. Ms Pavey asked:

Why not?

Mr Robinson said:

Ms Pavey interjected to defend district boards before Mr Robinson asked:

Here's to you, Mr Robinson. These are very sensible questions. The reintroduction of district and hospital boards will not improve health service governance or community involvement in health service decision making. What it will do is add layers of bureaucracy to the public health system. The existence of the 17 current area boards already leads to some conflict between areas, with boards making decisions they believe are for the benefit of their own areas, rather than the health system as a whole. The Government's reforms are designed to promote areas working co-operatively together, not competing with each other. The Opposition always wants the detail, so I am giving it. The Opposition's policy also assumes that health is just about hospitals. This ignores the important role played by community and public health services, aged care facilities, and the like.

The Opposition's policy also assumes that each hospital is responsible for providing its own services in isolation of other hospital services. This ignores the move away from facility-based planning to clinical streaming supported by clinical networks. For example, it will be better for experts in cardiac surgery to manage the way cardiology services are run across a number of hospitals, rather than have each hospital do its own thing. The Opposition's proposed amendments would create enormous structural anomalies in the public health system and. militate against any cohesive move to the integration of clinical services across area boundaries or across the State. It will be a fatal blow to the advance to integrate acute and community health services in order to ensure a well co-ordinated and seamless delivery of services to patients. Under the Opposition's amendments the chief executive of an area will be accountable to a multitude of masters, who may pull in different and sometimes contradictory directions.

The Hon. Robyn Parker: Will you reply to some of the concerns that we raised?

The Hon. JOHN DELLA BOSCA: I am dealing with the big picture.

The Hon. Robyn Parker: You are supposed to be replying to us.

The Hon. JOHN DELLA BOSCA: It is a reply to you. It is a reply to every single issue you raised. On the one hand, the chief executive officer will be directed by the board of each public hospital with more than 4,500 admissions each year located in their area health service. They can also be directed by the district board for those hospitals in their area that have less than 4,500 admissions each year. To add to the complexity, the chief executive can be directed by the director-general in respect of all matters unrelated to the affairs of the hospitals.

For example, in the new Sydney South West area, under the Opposition's proposed amendment we will have around nine local hospital boards directing operations for their particular hospitals, at least one district board directing operations for about another four hospitals and the director-general directing whatever is left. Hardly a good recipe for streamlined and sensible corporate governance, and sensible health service planning and delivery! Is the Opposition seriously suggesting this confusing and conflicting style of corporate governance? I give an example of how the Opposition amendment would disrupt clinical networking in the lower mid North Coast region. Manning Base Hospital and John Hunter Hospital are currently the clinical services hub in a network involving smaller hospitals in the region.

Under the Opposition's proposals those big hospitals, with their own local hospital boards under a separate governance structure to all the smaller hospitals in the network, will act in their own interests and focus their services on their own needs. This will result in a loss of expertise and support to the smaller hospitals, many of them rural. To top it all off, these boards will be totally unaccountable to the public through government. Under the Opposition amendment neither the Minister nor the director-general has the power to control the provision of hospital services. Neither the Minister nor health managers will be accountable for hospital services. When boards decide to issue directions contrary to the overall interests of the health system and in the interests of one community, the health system will suffer. Under the Opposition's amendment it is not clear when there will be a single hospital board or how many district boards there will be.

The Hon. Robyn Parker: Which amendment?
The Hon. JOHN DELLA BOSCA: The foreshadowed amendment. According to the Opposition, there will be a local hospital board when the average admission is 4,500 per year. What does this mean? Does it mean that when admissions fall below 4,500 in any particular year, someone will say to the board, "Sorry, you're gone because we've only had 4,499 in the last year"? Who knows? The amendments certainly do not shed any light on this. The Opposition has been dishonest about the effects of its own policy. The Hon. Don Harwin has wrongly stated that many smaller rural hospitals will have hospital boards under the Opposition's policy, and he used Milton hospital as an example.

The Hon. Don Harwin: Don't tell lies about Milton hospital. I know the policy. I wrote it.

The Hon. JOHN DELLA BOSCA: That is modest. The Department of Health has advised that the most recent annual admission figures for Milton-Ulladulla Hospital were 2,509. The Opposition is misleading rural communities that they will have local hospital boards. Under the Opposition's policy only about 18 rural hospitals would have a local hospital board, and 115 would not.

The Hon. Don Harwin: That is not true. Milton hospital would have a board.

The Hon. JOHN DELLA BOSCA: The Hon. Don Harwin will get his chance to speak. And when do we have a district board? Again the amendment allows for as many as there are hospitals with less than 4,500 annual admissions, whatever that means. The Opposition wants to take us back to circa 1929 and the days of the old Public Hospitals Act when institutional hospital care was the norm and systems of integrated and co-ordinated community care and population health systems were either non-existent or completely separate. We have moved a long way from that over the years, culminating in the area health service system introduced by the Labor Government in 1986, and built upon and refined by successive governments, Labor and Coalition.

Getting down to the machinery of the boards, the Opposition clearly cannot make up its mind whether it wants to pay these board members. In debate on this bill in the other place the honourable member for Ku-ring-gai directly criticised the payment of board members. He said, "Participation on boards will be voluntary". However, the Opposition's amendment declares the board members' offices to be "honorary". In the next breath it is suggested they can be paid whatever the Minister decides. Then there is the cost of all these boards, however many we end up with. Department of Health estimates indicate that it costs about $200,000 per annum to support a hospital board. Of approximately 218 hospitals in New South Wales, about 57 have more than 4,500 admissions—37 of them in metropolitan areas.

Providing hospital boards for the 57 hospitals would cost $11.4 million. It is not clear how many district boards the Opposition would establish, but assuming they return to 23 rural district boards, as was the case under the previous district structure, that would be one district board per five rural facilities. Applying this ratio for metropolitan district boards would result in there being nine metropolitan boards. The cost of 32 district boards would be $6.4 million. The total cost would be $17.8 million—and that is before we even start thinking about remunerating the members. The Opposition amendments will be the death of clinical networking in this State and any semblance of sensible corporate governance in the public health system.

They will result in health services in our smaller rural communities withering on the vine. The Opposition's policy of restoring local and district boards creates new layers of bureaucracy, diverts resources away from front-line care, encourages isolation and division rather than co-operation, compromises community and clinical participation, ignores non-hospital health services, and ignores clinical streaming and networking. The Hon. Don Harwin asserted that the Government's reforms will reduce local community input into health service planning. The Health Services Act provides that area health services are to consult with health professionals and encourage community involvement in health service planning, but has never been sufficiently prescriptive as to how this should occur.

The corporate accountabilities for area health boards also provide that boards are responsible for ensuring structures and strategies are in place to actively and genuinely engage local communities in planning and decisions affecting delivery of health services. Notwithstanding this and the good intentions of area board members, boards have generally struggled to successfully engage clinicians, and particularly the community, in health service planning and delivery. The New South Wales Independent Pricing and Regulatory Tribunal [IPART], in its September 2003 report entitled "New South Wales Health—Focusing on Patient Care", highlighted the problems of the current system in this area.

The role of boards has been one of governance and, quite properly, board members have generally focused their attention on corporate governance matters, such as financial management, risk management, work force development, medical appointments, research, et cetera. There has also been fundamental tension between the boards' governance role and the necessary community and clinician advocacy and advisory roles identified by IPART. Area health advisory councils will be entirely dedicated to bringing health consumer, community and clinician views to the attention of the highest level of area health service management and to reporting back to clinicians and the community.

In recognition of the geographical size of the new areas, the Minister for Health will appoint 13 members to the area health advisory councils for the new Greater Western, Greater Southern, North Coast, and Hunter and New England area health services. It must also be remembered that area health advisory councils are not intended to be the only voice for communities in health service decision making. Area health advisory councils cannot be directly representative of every single community or health interest group. If they were, they would be so large as to be unworkable. As the Government has made clear from day one, all existing local health participation groups will continue to operate. As noted by the Clinical and Community Advisory Group:

An important part of the Area Health Advisory Council's role will be to review these existing local level community participation arrangements. There will be no legislative principles for contract of employment or requirements for performance review. Health executives will continue to be employed by different health organisations, increasing the scope for the inconsistent management of health executives.

The Parliament will lose an opportunity to facilitate an integrated approach to executive development and promotional opportunities within NSW Health; a consistent approach to executive performance management and review within NSW Health; and clear lines of accountability of senior health executives, through chief executives to the director-general, consistent with the director-general's already established role of monitoring the public health system and performance review of public health organisations and chief executives. The reforms in this bill, which we expect to be carried unamended, are sensible and will improve health services and accountability across the health system. I commend the bill to the House.

Question—That this bill be now read a second time—put.

The House divided.

Ayes, 18

Mr Breen
Ms Burnswoods
Mr Catanzariti
Mr Costa
Mr Della Bosca
Mr Egan
Ms Fazio

Ms Griffin
Mr Hatzistergos
Mr Jenkins
Mr Kelly
Reverend Nile
Mr Obeid
Mr Oldfield

Mr Tingle
Mr Tsang

Tellers,
Mr Primrose
Mr West

Noes, 13

Dr Chesterfield-Evans
Mr Clarke
Mr Cohen
Mrs Forsythe
Mr Gay

Ms Hale
Mr Lynn
Ms Parker
Mr Pearce
Ms Rhiannon

Mr Ryan

Tellers,
Mr Colless
Mr Harwin

Pairs

Mr Macdonald	Ms Cusack
Ms Robertson	Mr Gallacher
Mr Roozendaal	Miss Gardiner
Ms Tebbutt	Mrs Pavey

Question resolved in the affirmative.

Motion agreed to.

Bill read a second time.

Consideration in Committee ordered to stand as an order of the day.

BUSINESS OF THE HOUSE

Postponement of Business

Government Business Orders of the Day Nos 8 to 13 postponed on motion by the Hon. John Della Bosca.

SMOKE-FREE ENVIRONMENT AMENDMENT BILL

Second Reading

The Hon. HENRY TSANG [Parliamentary Secretary] [8.59 p.m.]: I move:

I seek leave to incorporate the second reading speech in Hansard.

Leave granted.

Ban smoking at counter areas
Make one bar non-smoking in multi-bar venues, and
Make one gambling or activity room non-smoking, in multiroom venues with more than one room for each activity.

No smoking at any counter where drinks are ordered or served
In venues that have more than one bar room, one room must be smoke free
In venues that have more than gambling area or recreation room, at least one of each area or room offering a particular activity must be smoke free.

The Hon. ROBYN PARKER [9.00 p.m.]: The Smoke-free Environment Amendment Bill phases out smoking in enclosed areas. I will deal with the definition of "enclosed area" later in my speech; there is some confusion about it. Nevertheless, the bill phases out smoking in enclosed areas of hotels, clubs, casinos and nightclubs by 1 July 2007. The table game area of Star City Casino's high roller room will be exempt, subject to an annual review, similar to exemptions in legislation in other States. The bill seeks to prohibit smoking from 1 January 2005, as per the voluntary "share the air" bans, in gaming machine venues with more than one gaming machine, and from 1 July 2005 in foyers, dance floors, toilets and auditoriums.

The bill provides for the following temporary exemptions during the phase-out period: from 1 July 2005 to 30 June 2006, one bar, gaming or recreation room or area comprising up to 50 per cent of the area of such rooms; and from July 2006 to June 2007, one bar, gaming or recreation room or area comprising up to 25 per cent of the area of all such rooms. The Act will also allow for new regulations to deem when a covered outside area is enclosed. Smoking areas—exempt areas, as they are termed—must be separated from non-smoking areas by a partition or a 1.5 metre buffer zone. I interpret that to mean a row of large pot plants, for example, but not necessarily a floor-to-ceiling wall. That definition is a little hazy, if you will forgive the pun, as I would have thought smoke would drift across any barrier.
The bill allows for a gradual phasing-in, but not quite the phasing-in that some hotels and clubs expected. They were expecting these bans to be in place by 2007. From discussions we have had I do not think they were prepared for the January 2005 deadline because of the short lead time, which will cause difficulties with costs and planning approvals—provisions that differ from those agreed in the "share the air" proposals. Whilst hotels and clubs were aware of the 2007 deadline, the short lead time to January 2005 will cause some problems for some in the hotel and club movement with whom the Opposition has had discussions.

Smoking is obviously legal and is a matter of choice. In this country people have a right to smoke cigarettes. There is evidence worldwide of the harm that smoking causes to one's health—as there is about the over-consumption of alcohol—but at the end of the day people make such choices and it is not for others to tell people how to live their lives. However, it is important that we take steps to minimise the harmful effects of passive smoking and to make the environment safer for those who are not actively participating in smoking.

Smoking is an interesting debating topic because individuals have a right to smoke and because tobacco is a legal substance. We tend to look at the harmful effects of smoking on those who have decided they will smoke rather than discuss, as we should more often, the realities of the effects of smoking. The World Health Organization has identified smoking as the single most preventable cause of disease in the developed world. Smoking-related diseases claim more than 90,000 lives annually in Australia. That is roughly the equivalent of the entire population of Mount Isa. It is also equivalent to the loss of life that would result from one jumbo jet filled with passengers crashing every week. From my comments honourable members will realise I am personally against smoking and the harmful health aspects of smoking, and the statistics support my view.

Each year smoking kills more than 10 times the number of people killed on Australia's roads. Tobacco is responsible for around 82 per cent of drug-related deaths compared with around 16 per cent for alcohol and only 2 per cent for illicit drugs. Smoking is a major cause of heart disease and is associated with more than 30 per cent of all cancers, including lung cancer, cancer of the oesophagus and larynx, cancer of the stomach and cancer of the uterus, et cetera. Smokers are 10 times more likely to die of lung cancer than are non-smokers. Other conditions such as colds and gastric ulcers have also been linked to smoking. It is well known that smoking accounts for 30 per cent of all cancer deaths, but smoking also contributes to death as a major cause of cardiovascular disease and pulmonary disease. One in two smokers eventually dies of smoking-related illness and approximately one in six long-term smokers develops lung cancer.

Because of the complex nature of smoking, increasingly, attempts to tackle the problem have to be multifaceted. This bill is only one way to reduce the harmful effects of smoking. Its provisions must be combined with continuing education programs. The bill at least goes some way towards creating some sort of enforcement approach to smoking. Smoke-free environments attempt to protect hotel and club workers, entertainers and patrons from the harms of passive smoking.

I recall growing up in a household of smokers. I spent time with my grandmother in an environment where everybody smoked. In hindsight I wonder just how much smoke I inhaled during that time. As a non-smoker I am very aware of the smell of cigarette smoke. My son recently started playing in a band that plays at a number of venues at which patrons smoke. Entertainers are exposed to an incredible amount of passive smoke. My son comes home smelling strongly of cigarette smoke; he has no choice in the matter. The bill will provide at least a small amount of protection for entertainers and people who work in hotels, clubs, restaurants and other venues. Evidence about the dangers of passive smoking is mounting.

It is difficult to balance the rights of smokers against the rights of those who do not smoke. I understand that people have the right to participate in a legal pursuit. However, we are looking at ways in which to provide protection and rights for everyone. The people who make the choice to smoke have their smoke filtered by the cigarette they are smoking, whereas the lungs of passive smokers are not protected even slightly. Sidestream smoke is unfiltered and has a much lower temperature than smoke inhaled by smokers, and this means that the poisons in the smoke are not burnt out. Some evidence suggests that sidestream smoke is 130 times stronger than smoke inhaled by smokers. I do not have a source for that information; it is just off the top of my head. It is claimed that sidestream smoke contains up to 15 times more carbon monoxide and up to 21 times more nicotine than smoke inhaled by smokers. The particles that make up sidestream smoke are small and are therefore easy to inhale and they remain in the body longer.

In addition, passive smoke causes irritation to the eyes and nose, and can aggravate asthma and bronchial conditions. In some legal cases, passive smoking has been found to cause permanent damage. As with normal smoking, the damage depends on the amount of contact. Occasional contact with people in a smoking environment certainly does not have the same effect on non-smokers as sustained and long-term contact with people in a smoking environment, such as is experienced by those who work in entertainment environments, and behind the bars of clubs and hotels.

The bill provides that from 1 July 2007 smoking will not be permitted in enclosed spaces in licensed premises. The Opposition welcomes this provision, as I am sure do a large number of people in New South Wales. However, I have concerns about what will happen before 1 July 2007 with regard to exemptions and what will constitute an outdoor area. The bill provides for temporary exemptions during the phase-out period, allowing for exempt smoking areas to be separated from non-smoking areas by the buffer zone that I referred to earlier. The concern is that buffer zones in single rooms will simply be artificial barriers that will be of no real benefit to non-smokers and workers because there is no requirement for an actual barrier or an air extraction or exhaust system. The Australian Medical Association has mounted a strident campaign against smoking. Its President has been very involved in this campaign over the past 12 to 18 months. The association argues that patrons are being fooled into believing that they are in a smoke-free area when all that stands between them and a smoking area is some kind of partition.

I acknowledge that, having regard to the short lead time, the hospitality industry must be given time to accommodate the new laws. Further consideration of these exemptions will provide greater health benefits, and that is what the bill is all about. We are disappointed that the bill does not deal more directly and specifically with enclosed outside areas. The bill allows for new regulations to define whether a covered area is deemed to be "enclosed". It is unfair to the owners of hotels, clubs and bars for this matter to be contained in regulations. We are asking them to make major changes to the way they do business, yet the Government has not defined for them what is meant by an "outdoor area". So it is difficult for them to make any changes. We have to protect their opportunity to do business, and I am sure many of them want to adhere to the legislation. But it is unfair not to provide that sort of information in the bill. A matter that will have a significant impact has been left out of the bill and will be covered later in a regulation. If the definition were included in the bill, the owners of hotels, clubs and bars would know where they stand and what their responsibilities are.

We must also ensure that the financial viability of venues is protected. Assurances have been given in this regard, but we would all be aware that proprietors are concerned about the long-term effects. Legislation to ban smoking in public areas in California has had an enormous impact. California has had smoke-free bars since 1998. In that year, per capita cigarette consumption declined by more than 40 per cent. In California virtually all places of indoor employment, including restaurants and bars, are now smoke-free and 64 per cent of all homes apply a voluntary smoking ban. This means that 87 per cent of all children are protected. Last week the Scottish Parliament passed legislation that will ban banned smoking in public buildings from 2006.

The Sydney Morning Herald reported today that the British Government plans to impose a sweeping public smoking ban across England and Wales. We must look at the potential impact of banning smoking in such venues in this State. Does that mean people will be outside on the footpath drinking and smoking? In what position does that put the general public? If we get to the point at which local government interferes and there is a great deal of confusion, the aim of the legislation will be defeated. Councils should not have the opportunity to tinker with the legislation and thereby negate some of its positive effects.

The Opposition has other concerns about the consultation process. The restrictions and share-the-air bans left much of the industry feeling as though it had not been effectively consulted. The short lead time raises legitimate concerns in clubs and pubs across the State. Those businesses, which employ a large number of Australians, should be given consideration. They should be given a reasonable lead time during which to implement legislation that will have such a dramatic effect on them. These businesses should be given assurances about possible loss of revenue as a result of being required to provide smoke-free environments. They should also be assured that the no-smoking policy applied to hospitality venues will not harm their businesses. Indeed, their businesses could improve as more people might use their venues because the environment will no longer present a passive smoking risk and there will be equitable access to entertainment venues because people will smoke in designated areas and non-smokers will not have to endure the effects of smoking while having a drink with friends.

A review that has been undertaken suggests that there will be no adverse economic impact on smoke-free pubs and hotels as a result of this legislation. I know that the proprietors of these premises would like an assurance along those lines from the Government. Perhaps the Minister will provide further information about the findings of that review. Bar and tobacco lobbyists predicted the loss of 65,000 jobs if New York's hospitality venues went smoke-free. In fact, employment in the sector increased by almost 10,000 and bars and restaurants paid 12 per cent more in business tax in the year after the bans were imposed than they did in the previous year. That indicates that being smoke-free is good for business. More recently, Ireland and Norway have followed suit with totally smoke-free pubs, clubs and casinos. As I said previously, last week the Scottish Parliament banned smoking in public buildings from 2006.

I hope the Government continues to work and consult with the hospitality industry until January to ensure that the short lead time does not have a detrimental effect or create liability issues prior to the legislation coming into effect. I hope clubs and hotels will take comfort from the fact that research shows that 77.9 per cent of people who regularly attend hotels do not smoke. About a decade ago that figure would have been closer to 60 per cent. That is an indication of how many people are quitting the habit or not taking it up. Another Australian survey indicated that half the respondents said that the smoke-filled environment was their reason for not going to hotels and clubs. I hope that continues to be the case and that, for the sake of those businesses, people decide to enjoy themselves at those venues. I support my son's rock and roll band and I would be very pleased if the venues he played at were smoke free so that I did not have to suffer passive smoking.

This bill brings the State's legislation more in line with legislation in other States that have imposed total and partial smoking bans. It will eliminate and minimise exposure to environmental tobacco smoke, and that will obviously have a positive impact on the health and wellbeing of all residents of New South Wales, particularly those working in the hotel and club industry. The Opposition does not oppose the bill.

The Hon. DON HARWIN [9.27 p.m.]: I almost feel unqualified to participate in this debate because, as a fanatical opponent of smoking, I have never smoked a cigarette in my life. I hate the things! It is wonderful that we are finally debating this bill. I do not pretend to do anything in this speech other than represent myself, given the highly inflammatory remarks I am about to make. I take this opportunity to pay personal tribute to all those from many organisations who for so long have done what they could to highlight the dangers and evils of smoking and to bring us to the point at which one of the things that aggravates me more than anything else—a smoky, enclosed space—will soon be a thing of the past in New South Wales.

The Smoke-free Environment Act prohibits smoking in an enclosed public place. However, it contains certain exemptions in relation to a hotel, club or nightclub. Of course, the object of the bill is to phase out those exemptions by 1 July 2007. That date cannot come soon enough as far as I am concerned. Sadly, the New South Wales Government has spent a very long time consulting and negotiating with hotels and clubs. During that decade the occupational health and safety of workers in the hospitality industry have not been given the priority they deserve. As patrons we can choose not to go into smoke-filled hotels, clubs, pubs or restaurants. However, there are plenty of people who but for their jobs in the hospitality industry would not have a livelihood. It is a great day for them that the end is in sight.

There are a few problems with this bill, but it is a great step forward. One of its problems is that the definition for "outdoor area" was not included in the bill. It has not been, and I am concerned that the health benefits that are expected to flow from this legislation may be watered down by the definition of an "outdoor area" in the regulations. I am sure we have all sat in a coffee shop or restaurant that has a bi-fold door opening on to the pavement, separating smoking patrons outside and non-smoking patrons inside. The patrons inside, in what is supposedly a smoke-free environment, are forced to suffer when the wind carries the cigarette smoke inside. It makes a mockery of the whole idea of a smoke-free environment.

Those sorts of problems are going to continue under this legislation and, to be totally fair about it, I am not one who believes that you can simply say smoking should be banned in outdoor areas, in coffee shops, and in restaurants. That is unrealistic. There has got to be a balance in this legislation between the rights of people who are participating in what is a legal, although completely stupid and unhealthy practice. Those people have to be able to smoke somewhere, but patrons have to be protected and, importantly, hospitality workers also must be protected.

It is going to be difficult to draft regulations that will satisfactorily define what an outdoor area is, but I still think that the Government, having taken almost 10 years to introduce this bill, could have gone that extra mile and defined "outdoor areas" in the bill. It has been said that 90 per cent of the health benefits from this bill will be available from 1 July 2005. I certainly hope that is true, but I am very sceptical about that because that is based in large part on the idea that large, open spaces can be artificially divided into smoking areas and non-smoking areas. The reality is that there will be very few existing premises that have the sort of air-conditioning systems that will be needed to support allegedly smoke-free environments in enclosed areas.
In reality, this legislation will not confer most of the health benefits until a complete smoking ban is introduced in 2007, rather than in 2005, as has been represented, although we will start to see some benefits from the middle of next year. I just do not think that is realistic. I am sure that plenty of members have experienced being in areas that were allegedly smoke-free but, because of the nature of the building, the cigarette smoke just wafted into the smoke-free area, resulting in other people being subjected to passive smoking. So, there are a few problems with the bill, but, given the health impacts of smoking, we can be happy that the bill is a start.

Tobacco smoke contains around 130 toxic substances and 43 carcinogenic substances. Smoking accounts for an estimated 84 per cent of lung cancers in men and 77 per cent of lung cancers in women. It accounts for an estimated 73 per cent of larynx cancers in men and 66 per cent in women. It accounts for an estimated 57 per cent of mouth cancers in men and 51 per cent in women.

The Hon. Dr Arthur Chesterfield-Evans: Highly conservative figures.

The Hon. DON HARWIN: They may be highly conservative but they are the Quit Victoria study figures, and I rely on them. In addition to its association with cancer, smoking is strongly associated with cardiovascular disease, stroke, emphysema, hypertension, peptic ulcers, eye cataracts and macular degeneration—both of which can lead to blindness—impotence, and premature facial wrinkling. There are approximately 142,500 smoking-related hospital admissions in Australia each year. These are the 1997-98 figures, the latest I could find. There were approximately 19,000 smoking-related deaths in Australia in 1998, and I am sure that, if anything, that number is probably increasing rather than decreasing—although I hope that is not the case.

So-called environmental tobacco smoke—passive smoking—is smoke that is exhaled by smokers or smoke that comes directly from burning cigarettes, pipes and cigars. Passive smoking increases the risk of lung cancer, heart disease, asthma, chest infections and eye irritations. In children passive smoking increases the risk of middle ear infections, croup, bronchitis and asthma. That is what smokers are doing to their children.

In 2001 only 21.1 per cent of men and 18 per cent of women smoked in Australia. Among men, the age group with the highest rate of daily smoking is the 20 to 29 year age cohort, and they account for 28.5 per cent of male smokers. Among women, the age group with the highest rate of daily smoking is slightly older: it is the 30 to 39 year age cohort, which accounts for 24.3 per cent of female smokers. A 1999 survey of Australian secondary school students found that 6 per cent of 12-year-olds smoked, while in the 17-year-old age bracket 33 per cent of boys and 30 per cent of girls were smokers.

I have absolutely no doubt that most people strongly support smoke-free environments, and in passing this bill tonight we are not only doing something that the latest surveys indicate has the support of 70 per cent of people in the community, we are also doing something that is right, and that is important too. Total indoor smoking bans are certainly supported by the majority of hospitality workers, including musicians and entertainers. Thank goodness they do; they would be mad if they did not. A report to the Cancer Council in April 2004 by Professor James Repace estimates that between 73 and 97 deaths from heart disease and cancer can be attributed to smoky workplaces in New South Wales every year—and 59 of those people are non-smokers.

A recent Heart Foundation survey of pub and club managers found that 83 per cent believe that smoking restrictions are best achieved through legislation, 72 per cent say a total ban is inevitable, 80 per cent believe that cigarette smoke can damage the health of their workers, and 80 per cent believe that cigarette smoke can damage the health of their patrons. So the people who manage these venues know the risk, and I am pleased to see from that survey that they understand that something needs to be done about it. There has been concern in some quarters about the economic impact of the legislation, and I suppose that pub and club managers might be expected to be worried about that. But, as those survey figures show, they are overwhelmingly in favour of change.

There are smoke-free environments in a number of jurisdictions around Australia and, arguably, New South Wales has been dragging its feet. For example, a total ban in Australian Capital Territory pubs and clubs will take effect in December 2006—before New South Wales. South Australian legislation for a total ban in pubs and clubs will take effect in 2007—New South Wales is ahead of that State. Victoria already requires one smoke-free room if there is more than one room; and gaming machine areas in one-room venues must be smoke-free. In Queensland, smoking is already banned in bingo areas and around gaming tables. In the Northern Territory, hotels already must provide smoking and non-smoking areas. In Tasmania all nightclubs, cabarets and gambling areas are to be smoke-free from January 2005. So Tasmania is the place to go. From December 2006 in Western Australia, smoking will be allowed in only one bar or room in hotels, taverns, and other licensed venues.

My colleague the Hon. Robyn Parker averted to legislation around the world, so I will not go through that in detail. Suffice to say that Norway announced a nationwide ban on smoking in restaurants and bars in June this year, and opinion polls show that the majority of the population overwhelmingly supports it. Even Ireland, with its historic pub culture—which has played such a role in our own pub culture through the enormous and wonderful Irish heritage we have in Australia—introduced smoke-free pubs and clubs in March 2004.

New Zealand will ban smoking in pubs and clubs from December 2004 and six American States have total or partial bans on smoking already in clubs, pubs and restaurants. As my colleague noted, today the United Kingdom Government announced a ban on smoking in all workplaces and anywhere that food is served. The ban will affect most pubs, restaurants, cafes, offices, and factories. That is fantastic. Finally—I cannot help this personal idiosyncrasy—the land where gross national happiness, not gross national product, is the national objective—Bhutan—has gone completely smoke-free. I am determined to get there one day.

Some people have used the impact on business as an argument against this bill. In Ireland the number of non-smokers visiting pubs and bars has increased since the ban was introduced, and the number of smokers visiting has remained unchanged. It is interesting that the ban is not driving away smokers but is bringing back non-smokers. In New York, employment in the hospitality industry increased after the introduction of the ban, with a 12 per cent increase in business tax paid by bars and restaurants since its introduction, suggesting improved business.

Finally, the taxable annual sales in eating establishments in California has increased since the smoking ban was introduced in 1998. I dare say that no member of the House will vote against the bill. I very much welcome it and enthusiastically support it. The Opposition understands that industry feels there have been some problems with consultation and lead times but, overwhelmingly, the bill is in the public interest and it will be our great pleasure to not oppose it.

Reverend the Hon. FRED NILE [9.42 p.m.]: On behalf of the Christian Democratic Party I am pleased to support the Smoke-Free Environment Amendment Bill. This is an historic moment because the bill closes loopholes in the original legislation, which provided various exemptions with respect to bars and hotels. I acknowledge that it has been a slow process. The bill will phase out smoking in enclosed public places in licensed premises in two stages. From July 2005 smoking will be banned in thoroughfares, dance venues, auditoriums and toilets and all but one bar or gaming area in each premise. Partial bans will become law from the commencement of the legislation, including restrictions that are currently part of the voluntary agreement that will come into effect on 1 January 2005.

There will be increasing restrictions from July 2005 and July 2006, with a complete ban from 1 July 2007. Even though this bill has been introduced in 2004, the final loophole will not be closed until there is a complete ban from 1 July 2007. By coincidence, that is after the March 2007 election and one wonders whether a Coalition government will have a different view if it wins that election. It is interesting that the Labor Government has chosen a date following the next election. Perhaps the smoking lobby hopes to amend the legislation at that time.

I have been a passionate critic of the impact of smoking on the health of individuals and I have a deep concern about the effect of passive smoking. I have experienced health effects first-hand because my wife and I have bronchial asthma, which is easily irritated by smoke, even when coming from some distance away in a restaurant or from a passer-by in the street. Even without those health problems I would not have supported smoking, but they have made us aware of the impact that smoking has had on our own health.

My parents and my wife's parents were heavy smokers, so there was a lot of smoking in our homes. We grew up in that environment, but at that time people did not think smoking would have adverse long-term health effects upon people in their fifties, sixties and so on. Obviously our parents would not have smoked if they had known the impact it would have on their children. My wife's mother died tragically from the effects of smoking and we witnessed her gasping for her last breath in Bankstown Hospital.
I have raised this issue since I was elected to Parliament in the 1980s. In November 1987 I asked the Hon. Deirdre Grusovin, who was then Minister for Consumer Affairs, whether the Labor Government would support the Federal Government's long awaited policy of enforcing non-smoking regulations to prohibit smoking on internal airlines, public and private bus transport, rail transport, and railway stations, to protect the public from the proven health dangers of passive smoking. In those days the proposals seemed radical, but now smoking is not allowed on those forms of transport and on railway stations. On 2 December 1986 I said in debate on the Public Health (Tobacco) Amendment Bill:

that would have been one of the first cases—

Subsequent to that speech I have suggested on a number of occasions that smoking should be prohibited in motor vehicles because it has a harmful effect on drivers and passengers and, as the Hon. Tony Kelly said, to prevent people throwing cigarette butts out of car windows, because that can start bushfires, which create havoc in our community.

On 22 September 1991 I introduced a private member's bill, the Tobacco Advertising Prohibition Bill. It was controversial at that time, and at one point it was strongly opposed by the then Coalition Opposition's spokesman, the Hon. Dr Brian Pezzutti. As we all know, he was a heavy smoker and always seemed to defend smokers. But eventually the Coalition changed its view on the bill, and I was pleased when my bill was passed by the House.

At that time the Tobacco Institute spent millions of dollars attacking me and misrepresenting what I was doing. The institute said that I was trying to ban cigarettes in Australia and that I was another Hitler. At that time John Singleton's company placed full-page advertisements in newspapers with a picture of me on a soap box, a bit like Hitler, with the words "Today tobacco, tomorrow the world". The company used other hysterical advertisements as well. I am pleased that they did not have any serious effect and that the legislation was passed.

I followed that up with questions about passive smoking. On 11 March 1993 I asked a question regarding the claims by the Tobacco Institute of Australia that passive smoking was harmless and that there should be no restriction on smoking in the workplace. As honourable members know, the Tobacco Institute of Australia is the propaganda arm of the tobacco companies. Rather than Philip Morris or other tobacco companies making statements, they put their money into the Tobacco Institute as their political lobbying organisation. I believe that the Tobacco Institute distributed false information that passive smoking was harmless to stop any move in the direction we are taking tonight with this legislation.

These organisations are powerful and well funded with millions of dollars, and they place a lot of pressure on governments. On 22 September 1996 I asked whether the tobacco companies were ignoring aspects of the Tobacco Advertising Prohibition Act 1991, which I had introduced. The tobacco companies were trying to get around that legislation by advertising cigarettes near cash registers in retail outlets—where posters were specifically prohibited—by arranging a large number of cigarette packets in a window or near the cash register to give the effect of a poster. Not only is tobacco a health danger, but the tobacco industry also uses many dirty tricks to circumvent the law. I am sure that attempts will be made to circumvent the legislation we are passing tonight.

On 24 October 1996 I commenced the second stage of my campaign against the harmful effects of tobacco by introducing the Smoking Regulation Bill, whose object was to regulate smoking in public places, including public places that are places of employment. The bill defined "public place" and it prohibited smoking in enclosed public places with certain exemptions. It made it in an offence to fail to obey the direction of an inspector or an occupier of premises to stop smoking in contravention of the proposed Act.
I was pleased that the Legislative Council passed that bill. The Smoking Regulation Bill, which was my second major bill on smoking, was the forerunner to the bill we are now debating. Indeed, we could be debating the Smoking Regulation Bill tonight. Perhaps for political reasons, the Government decided to change the title of the Smoking Regulation Bill to the Smoke-free Environment Bill, which was passed by both Houses. I asked further questions about the immoral way tobacco companies were still trying to get around the tobacco legislation. On 31 October 1996 I asked:

The battle with the tobacco industry is ongoing as it tries to find ways around the legislation. The industry blatantly breaches the legislation and should be fined heavily for doing so. On 8 April 1997 I asked the Minister for Community Services, representing the Minister for Health:

In fact, that did occur. On 8 April 1998 I provided further information that for the first time there had been a decline in the number of smokers in the community since surveys began tracking smoking addiction more than 20 years ago. I asked:

In other words, there were more deaths from the effects of tobacco than from all other serious diseases. On 2 June 1998 I asked whether New South Wales was ranked poorly by the Australian Medical Association when it came to efforts to reduce smoking, and whether the New South Wales anti-smoking education program was the worst in Australia. Again, I urged the Government to take more aggressive action. I asked:

The Hon. Michael Egan: Are you attacking me again?

Reverend the Hon. FRED NILE: Yes. These are all anti Michael Egan questions, but they are not directed at you personally. It is opportune that the Treasurer has just entered the Chamber because on 29 June 1998 I addressed this question to him:

The Government had reduced its expenditure on those programs. I further asked:

The Treasurer simply replied:

On 14 October 1999 I supported a bill, which I suppose was radical in some people's minds, introduced by the Hon. Richard Jones: the Public Health Amendment (Smoking in Vehicles) Bill. That followed a campaign I had been promoting to prohibit smoking in cars and other vehicles for various reasons, particularly the impact of smoking on other people in the vehicle, let alone the driver. Of course, that bill was not passed. Then on 29 August 2000 I introduced the Smoking Regulation Bill, which is the predecessor to this bill. As I said that day, I was pleased to support the Government's Smoke-Free Environment Bill, especially because we had introduced the basis for that bill, the Smoking Regulation Bill, which was passed by the Parliament.

I was pleased that eventually the Government moved more aggressively with regard to the harmful effects of passive smoking. In 2000 I wrote to the Premier, and I quoted that letter in a speech on 29 August 2000. In my letter I asked the Premier to support the legislation to reduce passive smoking. In his response he stated:

He went on to say:

I was pleased to be able to work with the Premier on the original Smoke-free Environment Bill. On 13 June 2002 I supported a bill introduced by the Hon. David Oldfield—again, a private member's bill—to tighten up the laws dealing with the use and possession of tobacco by schoolchildren. His aim was to bring about uniformity in our laws. That private member's bill was not passed, but it is important to have it on the record that not only I but other honourable members have taken the initiative in regard to tobacco products. The Hon. Dr Arthur Chesterfield-Evans has done so for many years—probably longer than any other member in this House.

On 21 November 2002 I asked a question about Philip Morris, the tobacco company, trying to get around the Tobacco Advertising Prohibition Act by having special venues decorated for rave and fashion shows at Fox Studios. The company would put on a fashion show and use the Philip Morris logo and publicity as part of the setting, so it would become a tobacco advertising project. I asked the Government to investigate that. On 1 July 2003 I asked the Government about loopholes left in the original bill regarding smoking in bar areas, and so on, and whether it would move to close those loopholes. I asked:

This bill does not do that until 2007. The Government is moving forward at a snail's pace but, thankfully, we are moving forward. On 19 November 2003 I referred to another deceptive trick by tobacco companies and asked:

I asked whether the Government would investigate whether these additives were being put in cigarettes and finally ban smoking in hotels and club bars. I thought new members would be interested in the background of my involvement in the tobacco issue. Other members have referred to some tragic cases in which people have been seriously affected by passive smoking or environmental tobacco smoking [ETS], as it is referred to, which seems to be a very low-key description of something that has such a poisonous effect on people's health.

Thankfully there have been a number of very successful court cases over a number of years. People have gone to court over the effects of passive smoking in the workplace and have won large payouts. I know that one motivation for the Government is the long-term effect on WorkCover. If something is not done and if non-smokers working in the hotel and club industry find that they have lung cancer or some other serious disease, it will bring into question whether WorkCover has neglected its responsibility for people's health. I am not being critical when I say that is one motivation for the Government, but it has helped to focus the Government's attention on the need for this legislation to deal with passive smoking in club and hotel bars.

There have been some very large payouts. A man who worked for 35 years as a bus driver in Victoria and was exposed to tobacco smoke from passengers on his bus and from co-workers in the tearoom received an out-of-court settlement of $65,000 for lung cancer. Quite a number of large payouts have been made to people affected by passive smoking, including a flight attendant working on an airline; a teacher in a school, someone working in a golf club, and, sadly, even a nurse in the health industry in 1992, after 14 years employment with staff and patients who were smokers. I imagine that court cases brought by people affected by passive smoking will continue, but it is hoped that in the future, because of this legislation, there will be no new victims of passive smoking.
There is a lot of evidence against the arguments that the effects of passive smoking can be controlled by airconditioning, and I will not go into detail about that tonight. I think honourable members are aware of that information. Other countries are moving in the same direction. Only yesterday it was announced that England could become the latest country to ban smoking in public places, including restaurants and most pubs and clubs, and similar moves have been made in America and other countries. I am pleased to support this legislation. It has been a long, drawn-out battle but hopefully we are reaching the final stages in this victory.

Debate adjourned on motion by the Hon. Peter Primrose.

CRIMES AMENDMENT (CHILD PORNOGRAPHY) BILL

Bill received, read a first time and ordered to be printed.

Motion by the Hon. Henry Tsang agreed to:

Second reading ordered to stand as an order of the day.

ADJOURNMENT

The Hon. HENRY TSANG [Parliamentary Secretary] [10.09 p.m.]: I move:

That this House do now adjourn

BISHOP DANIEL AUSTRALIAN CITIZENSHIP CEREMONY

The Hon. JOHN RYAN [10.09 p.m.]: Last Saturday morning, 13 November, I had the pleasure of attending and representing Liberal Leader John Brogden at a ceremony to confer Australian citizenship on His Grace Bishop Daniel of the Coptic Orthodox Church. My colleague the Hon. David Clarke was also in attendance. This wonderful celebration of the work and achievements of Bishop Daniel took place in front of a packed church at the Coptic Cathedral of St Mary and St Mina at Bexley. The ceremony was colourful and festive. Musical events such as Coptic chants were provided by the diocesan deacons and students of Coptic colleges. A guard of honour was provided by members of the Coptic scouting groups. The event was attended by numerous other dignitaries, including Bishop Kevin Manning, the Catholic Bishop of Parramatta, his Excellency Mr Ahmed El-Kewaisny, Consul General of the Arab Republic of Egypt and numerous clergy from the local Coptic churches.

Mr David Macleod from the Department of Immigration and Multicultural Affairs, representing the Hon. Peter McGauran, Minister for Citizenship and Multicultural Affairs, administered the affirmation of loyalty and conferred citizenship on Bishop Daniel. His Grace Bishop Daniel has been serving as the leader of 50,000 members of the Coptic Church in Sydney since his enthronement on 12 October 2002 as the first Bishop of the Coptic Church for the Diocese of Sydney and Affiliated Regions, including New South Wales, Queensland, the Northern Territory, South-East Asia and North-East Asia. He has jurisdiction over the largest Coptic Orthodox diocese outside Egypt.

It was obvious from the event that Bishop Daniel is not only widely respected by his church but presents as an enormously humble and faithful servant of his church. It is obvious that the people who serve his church under him are inspired by his leadership and by his example. Of course, he is setting an excellent example for others who come to Australia from places such as Egypt by electing to take on Australian citizenship, and he sets a valuable example to all Australians by his contribution to the community. Under Bishop Daniel the Coptic Church is making a significant contribution to the wider community in Sydney and New South Wales, with organisations such as the Coptic Orthodox Youth Association, which co-ordinates a wide variety of youth programs including outings, sporting programs, social and musical events, and of course activities that support young people in taking an interest in religious life and devotion.

The Coptic Church in Sydney operates three schools—one at Wattle Grove, one at Mount Druitt and one at Bexley—and there are proposals for a high school at Berkshire Park in Western Sydney. The church also operates a migrant resource centre that provides assistance to newly settled migrants. Finally, it has a number of innovative programs supporting the elderly in their homes that use and train young volunteers, to the advantage not only of the aged people who receive these in-house services; they also develop the character and community spirit of the young people who participate in these programs.

Bishop Daniel has convened a committee to investigate proposals for a residential aged care facility to be located somewhere in Sydney in the future. It is obvious that this man exudes community service and is a wonderful example to the whole Australian community. He is a wonderful person to have become an Australian citizen, given his esteemed service to the Coptic Church in the wider world and also his outstanding academic qualifications. He has engineering degrees and impressive academic qualifications in civil engineering, computing studies and theology and at the moment is working on a doctorate. Besides being fluent in English His Grace also speaks Arabic, Coptic and Nubian.

He has had distinguished service within the Coptic Church, not only in Egypt but also in England. I wish him well in his future service in Australia and I know that now that he is an Australian citizen he will feel so much more one of us. It is a pleasure to see him enjoying all the rights and privileges of being an Australian citizen and being able to make this contribution to the Australian community. I congratulate him on his decision to become an Australian citizen and wish him well in his future service in the Coptic Church in Australia.

BONDI BEACH COLE CLASSIC OCEAN SWIM

Mr IAN COHEN [10.13 p.m.]: After 22 years the Bondi Beach Cole Classic, Australia's most popular community ocean swim, will cease to exist because of greed, bullying and the biased intervention of a local mayor. The Bondi Beach Cole Classic is an Australian icon that had its beginnings in 1982 when Graham Cole approached the North Bondi Surf Life Saving Club with an idea. His vision was for a community swim that encouraged and inspired all recreational swimmers to have a go, to set a personal goal of swimming two laps of Bondi Beach. It was not to be a race but a challenge to all people to make time, be disciplined and undertake regular training, to swim the 1.8 kilometre course through surf and then to take pride in achieving that goal.

Unknowingly, he was the pioneer of the ocean swimming calendar that we are so fortunate to enjoy today. Since its inception 22 years ago the Cole Classic has been organised as a not-for-profit event by the Cole family, who make up the Cole Classic Committee. North Bondi Surf Life Saving Club has hosted the event and provided water safety. North Bondi Surf Life Saving Club, which has hosted the Cole Classic for the past 22 years, and has been the recipient of profits from the event—last year receiving $18,500—recently announced that it would run its own ocean swim in place of the Cole Classic. This has happened despite the fact that the Cole Classic, a not-for-profit organisation with organisers who work on a voluntary basis, has been the biggest donor to North Bondi Surf Life Saving Club and for the proposed 2005 event had guaranteed the club a donation of $25,000, an increase of more than 25 per cent over last year's sum.

North Bondi Surf Life Saving Club rejected this offer and the Cole Classic Committee was given no alternative but to seek another club to host the event. The committee subsequently approached Bondi Surf Club to host the 2005 Cole Classic. However, this approach has been thwarted by Waverley Council, which has refused to grant permission for the Cole Classic to be run with the Bondi Surf Club, saying it wishes to limit the number and concentration of events on Bondi Beach. The Mayor of Waverley, a member of the North Bondi Surf Life Saving Club, was inappropriately involved in that decision and should have declared his conflict of interest and stayed out of it.

The council has nonetheless granted permission for North Bondi Surf Life Saving Club to run a new swim, the North Bondi Classic Ocean Swim, in place of the Cole Classic, on the first Sunday in February, the traditional date of the Cole Classic. Moreover, the council has also given North Bondi Surf Life Saving Club permission to conduct a second event, the Easts Roughwater Swim, on 9 January next year. Waverley Council's decision to allow North Bondi Surf Life Saving Club two ocean swims while refusing permission for the Cole Classic to be held has spelt the end for this icon of Australian community swimming at Bondi Beach after 22 years. Waverley councillors have since agreed to review beach events at Bondi. That is fine, but in only doing this much they have failed to address this key issue: they have refused another club permission to host the 2005 Cole Classic. The Cole Classic will now move to a community that wants it because its members appreciate the values it represents.

I have swum in the Cole Classic, as has Ms Lee Rhiannon, another member of this House. I first entered the event in 1995, and got a third place for my age group one year. The first time one year. It is a fantastic event with huge numbers, a flood of colour with the different age groups in their varied colour caps lining up to test themselves and have fun—and in my case to see people I have not seen for years. It is an iconic event, a gathering of those who are indeed steeped in Aussie beach culture, a sense of equal community stripped of any class or clothes difference and prepared to participate, often intensively, and prepare for the event. It embodies the clean ocean environment, a community event, a celebration of a healthy lifestyle and the good old Aussie attitude of have a go.

It is a great shame that there has been so much politicking going on, and that this event, the biggest swim on the calendar, the original swim on the calendar, has had to move to another area because of very small minded, petty and often bullying politics by local organisations that seem obsessed to gain financial and other advantages from the event and lose track of the original dream—the iconic approach, the wonderful and generous attitude of Graham Cole, who pioneered not only this event but the whole concept of ocean swimming races in the Sydney community.

SYDNEY WOMEN'S COUNSELLING CENTRE

The Hon. KAYEE GRIFFIN [10.18 p.m.]: I congratulate the Campsie Woman's Centre on its tenth anniversary and the launch of its official change of name to Sydney Women's Counselling Centre. The Sydney Women's Counselling Centre provides an excellent service for many women in need of support. The centre demonstrates a real commitment to providing services that support the psychological and emotional wellbeing of women. Counsellors and staff at the centre are very sensitive in identifying the social, environmental, physical and cultural factors that can affect women's health. Women who are professionally qualified conduct the counselling and support services in a supportive and friendly environment.

The centre offers a wide range of services for women, covering a variety of social issues that can affect their wellbeing. These include depression, grief and bereavement, sexual assault, self-esteem issues, alcohol or drug dependency and gambling. The services are conducted on a confidential and informed consent basis and, given some of the issues, the safety of the client is always a prime concern. The centre runs a very innovative program dealing with domestic violence. Up to one quarter of Australian women experience domestic violence in some form. Domestic violence is a difficult issue as it generally occurs behind closed doors with victims needing to find the courage to come forward and seek assistance. Whilst emphasis is often placed on healing the physical wounds domestic violence victims suffer, it is equally important to ensure they heal emotionally and psychologically. After an incident of violence in the home, victims are often reluctant or fearful to contact the appropriate support networks available to them.

The Canterbury Domestic Violence Proactive Support Project, or Yellow Card as it is known, is based at the Women's Counselling Centre and is a great example of co-operation between State and local governments. The project is co-ordinated through the Canterbury Domestic Violence Liaison Committee and supported by the Campsie Local Area Command. The Canterbury Domestic Violence Proactive Support Project aims to provide a follow-up support and referral service to victims of domestic violence in the local area who come into contact with the police. The project involves victims of domestic violence being provided with a yellow card to complete when Campsie Local Area Command officers attend an incident. This card asks for permission to refer the victim to the domestic violence support worker and provides a choice of times for the counsellor to make contact. The police then pass on this information to the support worker, who soon makes contact with the victim to assess her needs and provide advice.

The Sydney Women's Counselling Centre also provides assistance to women who are indirectly victims of common social problems, for example, women who have someone close to them with a gambling addiction, or drug or alcohol dependency. In these cases the services provided are aimed at minimising the harmful consequences of these problems and identifying a way forward for the women involved. The centre also occasionally runs therapeutic and educational groups for women who have similar needs. Staff at the centre run group sessions for women who are survivors of domestic violence and sexual assault, and group counselling for women dealing with substance use issues or relationship problems. There are sessions on parenting as well as an art therapy program for women to provide them with the opportunity for a creative outlet. The centre aims to be a resource for women by providing information on a variety of topics, including referral to other services addressing individual needs, for example, emergency accommodation or medical care.

Staff at the centre are also available to provide community education to promote awareness of issues affecting women's health. The centre staff make every effort to make their services available to all women regardless of race, income, sexual orientation or age. They have bilingual trained staff and deaf sign interpretation so that no woman is disadvantaged in accessing the service. There is no charge to the client in accessing the service. The funding comes mainly from grants and some donations, which are always gratefully accepted. The tenth anniversary is an opportunity to acknowledge the valuable contribution that the Sydney Women's Counselling Centre makes to so many women living in difficult and often dangerous circumstances. The centre is an important part of the support network for women. I place on record my thanks to the staff for all their work in the community. I particularly acknowledge Kristin Dawson, the co-ordinator, who has made an extraordinary contribution to the growth of the centre over the past 10 years.

MARRIAGE AND THE FAMILY

The Hon. DAVID OLDFIELD [10.23 p.m.]: This week my wife, Lisa, and I had the privilege of meeting the President of the New South Wales branch of the Australian Family Association, Mrs Mary-Louise Fowler. Mary-Louise and many committed and well-meaning individuals and organisations are doing their very best to promote the family. The family is the cornerstone of decent society and the matchless building block of any good civilisation. Unfortunately, there is a considerable ongoing attack on traditional families and traditional family life. Such assaults are largely the work of social engineers with personal agendas related to the justification and promotion of their own circumstances, not the welfare of the people, or for that matter, the nation. Among the material that I have received from Mary-Louise was the excellent booklet entitled "21 Reasons Why Marriage Matters". I seek leave to table this document.

Leave granted.

It is said that marriage is a man and a woman's ultimate expression of commitment to a lifelong partnership. The foundations of marriage include love, trust, faith and respect. My wife chose the traditional, "love, honour and obey" vows. However, I acknowledge that despite Lisa's chosen commitment at the time, I am not always successful in getting her to obey me. Of course, it is not all bad because I still enjoy love, trust, faith, respect, and obedience on occasion. Family usually flows from marriage, and I strongly believe every child has the right to the benefits of stable marriage. Equally, every child has the right to a mother and a father. I am very much opposed to planning children out of wedlock. However, more than that, I uphold that setting out to have a child as a single parent is irresponsible in the extreme. There was a time when people made sacrifices for their children, but these days there are many who give the impression that having children is the sacrifice.

The booklet "21 Reasons Why Marriage Matters" was published by the Fatherhood Foundation in co-operation with the National Marriage Coalition. It factually points out many things such as:

Marriage increases the likelihood that fathers have good relationships with their children…Cohabitation is not the functional equivalent of marriage…Daughters raised outside intact marriages are approximately 3 times more likely to end up young, unwed mothers than are children whose parents married and stayed married…Boys raised in single parent homes are about twice as likely to commit a crime that leads to incarceration by the time they reach their early thirties—boys raised in step families are 3 times as likely…Divorce and unmarried childbearing increase the economic vulnerability of both children and mothers.. Married couples build more wealth on average than singles or cohabiting couples…Children of divorced or unwed parents have lower academic achievement, are more likely to be held back, and are more likely to drop out of high school…Married men and women have lower rates of alcohol consumption and abuse than do singles…Marriage is associated with better health and lower rates of injury, illness and disability for both men and women…Married mothers have lower rates of depression than do single or cohabiting mothers…Single and divorced women are 4 to 5 times more likely to be victims of violent crime than married women and most particularly are almost 10 times more likely to be raped…Children living with single mothers, stepfathers, or mother's boyfriends are more likely to become victims of child abuse.

Research has found that pre-schoolers living with stepfathers are 40 times more likely to be sexually abused than those living with both biological parents. Australian research has also found that the typical child murderer is a young man in a de facto relationship with the victim's mother and that parental divorce is a factor for a wide range of social and psychological problems in adolescence and adulthood.

My mother, June, turned 81 today. She has been married to my father for nearly 50 years. Clearly they are an example of a couple with a strong commitment to marriage, each other, and their children. Indeed, I am extremely fortunate to be their son. No marriage is perfect because no person is perfect, and when marriage does break down it is not the fault of the institution but, rather, the people involved. Whatever faults the knockers may come up with, the positive aspects of marriage far outweigh any suggested negatives. We should choose our partner wisely, understand our commitment, and not fall for how easy society seems to have made divorce.

SRI LANKA-AUSTRALIA PROGRESSIVE ALLIANCE

The Hon. PETER PRIMROSE [10.28 p.m.]: Last Saturday evening it was my pleasure to attend a dinner in support of the Sri Lanka-Australia Progressive Alliance. I commend all involved in the organisation of the event, in particular my friend Mr Jagath Bandara. Guests heard a number of briefings on the current situation in Sri Lanka and, in particular, the role of the Janatha Vimukthi Peramuna [JVP] parliamentarians in projects throughout the country. A major project is centred on the reconstruction of lakes and storage tanks that were built in the days of Sri Lanka's ancient kings. Once completed, this huge project will ensure a stable and reliable water supply for local agriculture. This work is being carried out by the Sri Lankan Ministry for Agriculture.

One of the many interesting parts of the evening was an outline of some of the practical local projects in which parliamentarians and other members of the JVP were involved. These often involve what are known as "shramadana", which translates to "voluntary work". For example, in one district the local politicians are involved in a campaign with villagers every Sunday to widen a footpath between two villages in the area. Another project involved cleaning five hospitals and their surrounding environment. The tasks included cleaning and renovating wards over five days. At one hospital volunteers not only completely cleaned the hospital but also painted the wards. In another area a children's playground was constructed using volunteer labour; in another, books and sporting goods were donated to schools. The keynote speaker for the evening was Mr Nihal Ferando, who outlined the structure of the political organisation in Sri Lanka and the policies of the various parties and their activities.

Sri Lanka's most dynamic economic sectors now are food-processing, textiles and apparel, food and beverages, telecommunications, and insurance and banking. In 2003 plantation crops made up only 15 per cent of exports compared with 93 per cent in 1970, while textiles and garments accounted for 63 per cent. Gross domestic product grew at an average annual rate of 5.5 per cent in the early 1990s until a drought and a deteriorating security situation lowered growth to 3.8 per cent in 1996. The economy rebounded in 1997 to 2000 with average growth of around 5.3 per cent, but 2001 saw the first contraction in the country's history to 1.4 per cent due to a combination of power shortages, severe budgetary problems, the global slowdown and continuing civil strife. Growth recovered to 4.0 per cent in 2002 and 5.2 per cent in 2003. About 800,000 Sri Lankans work abroad, 90 per cent in the Middle East, and together they send home approximately $1 billion a year to the Sri Lankan economy.

When I arrived I indicated to those present that I personally knew very little about the political or economic situation in Sri Lanka but, like many others, I was interested in learning. I think all of us that evening learnt a great deal about this very interesting developing economy and its vibrant political situation. In summary, I congratulate Mr Jagath Bandara and all involved in a very successful evening.

TRIBUTE TO DR IAN O'ROURKE

The Hon. Dr ARTHUR CHESTERFIELD-EVANS [10.32 p.m.]: Tonight I pay tribute to Ian O'Rourke, a surgeon of note, who died on 16 August aged 60. I first met him at Orange Base Hospital in 1976 at which I was a senior resident medical officer and he was the new consultant specialist surgeon. He was very young and keen. He was quite a serious minded person with a great sense of purpose. He seemed to be the model "do-the-right-thing-by-the-establishment" sort of young surgeon. He was very enthusiastic, almost childlike. I can remember an occasion when we were searching for a splinter lost in a foot—a difficult proposition, even if you think you know where it is—and just as we were about to close up the wound, the splinter popped up through the wound and he said, "Look at that! It's like Jaws."

He was extremely conscientious. For the information of members, the treatment for an obstructed bowel is a naso-gastric tube and a drip. In those days we treated patients from Bloomfield psychiatric hospital who had been given high doses of antipsychotic medication, a side-effect of which is constipation with abdominal distension, which mimics bowel obstruction. Ian was very keen to treat these patients for bowel obstruction and the standard practice was to tie them down, insert a drip in their arm and, with great difficulty, a tube down their nose. Of course, the patients would free themselves, pull out the drip, bleed all over the floor and pull out the naso-gastric tube. He would insist that I tie them down again and put the drip and tubes back in. I must confess I favoured a far more laissez-faire treatment: I would give them some fluid and hope they stayed still and went to sleep. It was a somewhat difficult situation, but he did a very good job.

I remember saying to someone, "He is very serious and very good, isn't he?" And I remember the response, "Oh yes, but there is another side to him." I asked what it was, but I was never told. Certainly, he was very conscientious. He often used plastic skin, which he would spray on wounds. The skin had an extremely offensive odour, and I used to race to the other end of the operating theatre when he used it. From Orange he went to Westmead as the senior staff specialist, specialising in upper gastrointestinal surgery. Interestingly, he was the staff specialist—a position that is paid far less than that paid to visiting medical officers [VMOs]. He was very involved in teaching at Westmead. He graduated from the University of Sydney with a Master of Surgery, and he was a Fellow of the Royal College of Surgeons in England and a Fellow of the Royal Australian College of Surgeons.

From Westmead, where he had a very specialist practice, Ian went to Darwin, where he took on the general roster, I think because he thought he was doing more good there at a broader level than he had done at Westmead. It was indeed a strange move, going from a teaching hospital in Sydney to the Royal Darwin Hospital.

Dr Toyne, the Justice Minister and Attorney-General of the Northern Territory Parliament delivered a very moving eulogy at the funeral service held for Ian on 18 August. Ian ran a diabetic clinic in the Northern Territory; he took the trouble to do preventive work by managing diabetes in Aborigines, and by so doing greatly decreased the number of diabetic amputations that had to be performed in the Aboriginal population. It was his general practical approach to looking at the problem from top to bottom that so endeared him to people in the Northern Territory.

He was a member of the Doctors Reform Society, the medical organisation of which I was New South Wales president for some time, which tries to defend Medicare and salaried medical services. Ian was interested in service, not money—a fact alluded to at the service at Waverley Cemetery. He came back to Sydney in 2002 to head the Institute of Clinical Excellence, which strove for quality in surgery and to get everyone up to standard. He fought to institute clinical meetings that would honestly investigate treatment that had not succeeded in order to eliminate the potential for future mistakes.

He had input into the Walker inquiry into health services, which, of course, followed the Campbelltown debacle. He looked quite unwell at that time. I saw him walking on the footpath towards the ferry terminal—I was in a hurry for fear of missing my ferry—and I said to him, "Gee, you're not looking well, Ian." He said, "No, I've got lung cancer, didn't you know?" I said, "No, I didn't, actually." He said, "You'd better go to the ferry, mate, I'm very slow-moving these days." I apologised that I had to leave him and thought that I would catch up with him again. Sadly, he died three weeks later. He had had lung cancer for about a year.

He was a lifetime non-smoker, very interested in music and singing, and was a very active exerciser. I wonder if his use of plastic skin had been the irritant that caused his lung cancer. The ceremony at Waverley was attended by the Who's Who of the Sydney medical profession. I also learnt at his funeral that at a party to open his consultant practice in Orange, the trestle table collapsed while he was dancing on it. Hence the "tut tut" comment years before. He made a huge contribution and will be greatly missed. [Time expired.]

PRINCES HIGHWAY FUNDING

The Hon. DON HARWIN [10.37 p.m.]: The State Government spends five times as much on the Pacific Highway annually than it does on the Princes Highway. Despite the fact that the Princes Highway is a State Road and the Pacific Highway is a road that attracts funding from two levels of government, there is a large discrepancy between funding for the two highways. The population from Hexham to the Queensland border is 600,000; the population from Wollongong to the Victorian border is 430, 000. So there is no population reason for this mismatch.

Safety statistics show that the Wollongong to Nowra section is the worst part of the Princes Highway. There are 10,000 vehicle movements per day on that part of the highway, just as there are 10,000 vehicle movements per day on the stretch of highway between Hexham and Coffs Harbour. There are the same number of vehicles movements each day at Ballina and Tweed Heads. Despite this statistic there is no action still from Minister Scully. We are waiting to see the result of the safety audit on the Princes Highway. It is another excuse for inaction. I wonder how long the Minister has had the results of that audit sitting on his desk and has not taken the public into his confidence about what it says.

Clearly this section of the Princes Highway is in need of improvement. Police numbers are falling quicker in the Kiama electorate than in any other electorate in the State. The Minister refused to rule out stopping rail services to Gerringong and Berry today. The Kiama electorate obviously needs better representation, and it will get it after the next election.

[Time for debate expired.]

Motion agreed to.

The House adjourned at 10.39 p.m. until Thursday 18 November 2004 at 11.00 a.m.
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