Health Review
25/02/2015
The Hon. K.L. VINCENT: In summing up, I would like to thank my parliamentary colleagues for their contributions to this debate: the Hon. Mr Stephen Wade, the Hon. Ms Tammy Franks and the Hon. Tung Ngo, and those other members who have indicated their support without necessarily going on the record as such. I would take some issue (I am sure it is no surprise) with some of the comments from the Hon. Mr Ngo in which he seems to insinuate that I, as Dignity for Disability’s representative, have been nothing but critical of these reforms. If my memory serves me—thankfully I do not have to rely on my memory; I also have media transcripts—I have actually been, I think, rather positive about these reforms. We in Dignity for Disability have merely been critical of the lack of clarity around the proposed reforms and the concern that that is creating in the community.
The Hon. S.G. Wade: You said that in moving, too.
The Hon. K.L. VINCENT: The Hon. Mr Wade interjects (out of order, I know) that I also said that in moving the motion. I would like to give a few quotes from correspondence I have received from various professionals and members of the community about these reforms to again illustrate the lack of clarity and the concern around that in the community. This one I think is particularly relevant on the subject of emergency department closures:
There is widespread agreement for the need for greater efficiency in health care and there is a great merit in some of the ‘ Transforming Health ‘ proposals such as 24 /7 cover for emergency cardiac [and] stroke treatment, improved discharge pathways on weekends and the creation of a 40 bed ‘ waiting for placement ‘ unit to improve patient flow through the system. However, the doctors and nurses working on the ‘front line ‘ at Modbury Hospital [in this particular example] are gravely concerned about this proposed downgrade and the consequent loss of Acute Care and Critical Care services at Modbury Hospital.
Or this one on the subject of the Hampstead Centre:
The set up and layout of the Hampstead Centre is flat and very accessible for me and others with mobility issues because there is sufficient disability car parking near entrances, hand rails to lean on and I am generally able to walk the distance between th e buildings I use.
Or this one on the Repat:
Over the decades, the RGH [Repatriation General Hospital] has developed teams of medical specialists who have built up an understanding of the veterans’ needs and expertise in dealing with and resolving these problems. I t is like a house of cards — pull out one, and the whole will likely collapse.
This does not sound to me like anyone is being overly critical or denying the need for healthcare reform point blank. It sounds very much to me like members of the community who are just concerned about the way these reforms might look and, if they do not have that information, it is very difficult for them to make informed decisions about whether or not they agree with those reforms. I think that we can all agree that there is need for healthcare reform. We simply cannot have a healthcare budget that continues to grow exponentially, particularly when we are not getting a return for investment with improvement in the health of our community.
I am sure that we all want affordable, modern health care which delivers a timely service which the community can rely upon. Technology, surgeries and drug therapies available for the chronically or critically ill or injured are better than they have ever been, but they do not come cheap; I am sure that there is no denying that. What is and always has been timeless and will not change is that prevention is better and often much cheaper than a cure. Prevent someone from suffering heart disease and expensive bowel surgery at 50 years of age through a healthy diet and regular exercise and that person will probably not only have better health outcomes and lifestyle for themselves and their family but you will save the health system plenty of money. Prevent cancer through a healthy diet, exercise and support and again you save money and improve people’s quality of life and health outcomes.
No, we can never prevent all injury; I am not stupid enough to believe that. We cannot prevent all injury, illness or chronic disease, and it would be naive to think that we could, but with quality primary health care we can certainly lessen the burden on the healthcare system which currently exists. So, we all agree that there is a need for healthcare reform, but on how we do this we have widely varying views.
The Transforming Health document, while I am sure was well consulted with a select group of people, is light on detail. This lack of clarity on the peculiarities of the reforms is a serious cause of concern that is causing much unrest amongst patients, the community and most health professionals to whom I have spoken on the subject.
There are many of the reforms that have been welcomed by the sector, and again I make that point. In particular, bodies such as the Australian Nursing and Midwifery Federation have been widely positive and welcoming of these reforms, but even those mainly in support of these reforms admit that there is far too much to be nutted out before any of this can be properly implemented.
Dignity for Disability’s motion focuses on a few areas within our healthcare system, mainly rehabilitation, mental health and the need for collaboration between government departments. Firstly, we have two high-functioning rehab facilities in the Rehab and Hampstead. The Repat, I believe, has six gyms and what I am told by one particular health professional is Australia’s best hydrotherapy pool. How is that going to be replicated with the space constraints at Flinders? Do those running Transforming Health know that there are six rehab gyms at the Repat and, if yes, why have they not detailed in the document how this will be replicated at Flinders hospital?
It is all very well and good for people like those of us in this chamber, who are able to attend special parliamentary briefings, to get information through the media, to liaise directly with ministers and so on, but what about the people out there who are directly affected and directly using these services day in and day out who are not in the privileged position in which we find ourselves, who do not have those avenues to go to and who rely on a document such as the Transforming Health document to provide them with enough detail to make an informed decision?
I know that the government is capable of pretty effective and positive consultation like that we have seen under the rollout of the Disability Justice Plan. This arguably did not happen to begin with, but once some pressure was put on the government it did become very consultative and collaborative with stakeholders in that particular project. I am incredulous and simply do not understand why this kind of mentality only seems to have spread throughout that project. Surely it would not be hard for the government to follow its own example. Perhaps I digress.
The Hon. S.G. Wade: You have.
The Hon. K.L. VINCENT: I have digressed, I am told, but with good reason. What about hydrotherapy? As one example, I was on air with ABC radio 891 last week where—
The Hon. S.G. Wade: Name dropper.
The Hon. K.L. VINCENT: Name dropping again, I know—Professor Dorothy Keefe assured me that the closed down hydrotherapy pools would be replaced, but there is already a shortage of adequate hydrotherapy pools, as I have mentioned before. So how are you going to increase the number of hydrotherapy pools in South Australia, which is essential in any state with an ageing population. Again, I make the point that it is all very well and good for someone like me, who is able to call up the radio and get on air quite easily and talk to the good professor, but again I ask: why was that information about the new hydrotherapy pools proposed under the project not detailed in the document?
What about things like meal times? Are there going to be separate dining rooms for those in longer-term rehabilitation? Rehab requires discrete programs, particularly if they are in a mainstream hospital setting. On the subject of beds, if there are fewer rehabilitation beds, is there going to be a step-down facility for those in long-term rehab? None of these questions appear to have been adequately answered to allay some of the community concerns.
Hampstead provides world-class rehabilitation from brain injury, spinal injury, stroke and other traumatic injuries and health occurrences. It has outpatient services and a peaceful garden setting. My question is, again: has anyone measured the value of that to patient rehabilitation and wellbeing in the long term? The measures used to collect statistics do not seem to take completely into account everything provided in a health service, like what you might call the non-medical things such as the provision of a nice peaceful garden setting. We in Dignity for Disability certainly believe that you do need to take holistic stock of these measures and a true account of the effect that they have on people’s recovery and wellbeing. So many people who have contacted my office report how essential to their recovery these kinds of facilities at the Hampstead centre have been.
On the subject of mental health, as I have previously elucidated, I find it deplorable that only three pages of Delivering Transforming Health is devoted to our all too often crisis driven mental health system. As the Hon. Tung Ngo mentioned, the document aims to reduce waiting times in emergency departments. This is certainly something I am sure we can all get behind, but when we consider the fact that the document proposes reducing waiting times in emergency departments to four hours, I believe, for people with physical complaints compared to 24 hours for people with a mental health issue we have to ask: is this really the best that we can do?
Just because 24 hours is better than a worse option does not make it particularly good. The glaring gap of 20 hours in waiting time if you have a mental health issue again demonstrates that perhaps this government does not understand the true effect that mental health has on people’s lives and perhaps does not understand that a mental health issue can be just as debilitating and urgent, if not more so, than a physical complaint. That is of great concern.
I also would like to touch on the fact that the Hon. Mr Ngo, when talking about the area of primary health care, has touched on the fact that Transforming Health is meant to be—I think he used the word ‘overarching project’. Again, I labour the point that we do not deny the need for hospital reform, but what about keeping people out of hospital and the health outcomes that that can achieve and the money that that can save in the longer term?
I do not understand, and I am very interested to know when, in the minister’s mind, hospitals became the Mecca for all health and wellbeing, particularly for people with mental health issues. We know that keeping them in the community and connected to the things that make their lives routine, stable, connected and meaningful is vital. The lack of clarity around the importance of community support is very concerning.
In the absence of any detail, health professionals, patients and the broader community have jumped to the worst possible conclusion, because the Minister for Health and the government have failed to provide details. I am not saying that anyone in the community who has contacted me has been particularly misleading or alarmist. I believe it is simply human nature, when you hear that a service that you rely on or have relied on in the past is going to change and you do not understand that change, to be worried about that. It is very normal and understandable.
The government has once again, as it did on emergency service reform, said, ‘Trust us, everything will be fine.’ They are saying that it will all be for the better, not worse, and yet we have no real concrete evidence to work out how that will be so. How do we know that this will provide better services than those we already have? Some of that we do and I again add that some of the proposals have been very welcome. However, the less consultative governments are the easier it is for people to jump to conclusions.
Again I labour the point that the best way to get good outcomes is to involve the people who will be directly affected by those outcomes, particularly in terms of promoting primary health care for all South Australians. Dignity for Disability is saying that we want our taxpayer dollars to build a fence at the top of the cliff and not fund an ambulance to pick up the pieces at the bottom, as the old saying goes—and perhaps is has never been more fitting.
It is clear to me that the public does not feel adequately consulted or confident in what the government is currently offering. Therefore, I am not saying, ‘Blow up the entire project. Let’s not reform the healthcare system; it’s too hard.’ We all know that needs to happen, but do it in a way that respects and listens to the concerns of real people who are directly affected by these services. The government must take action to restore confidence in this process, both for the sake of people using the healthcare system and for its own sake, for its own reputation and to do its job properly. Again, if we do not involve the people who are directly affected it is not going to help anyone.
If people in the community and SA Health employees thought that they were listened to and that their suggestions would be implemented, then I am sure that they would not be calling my office (and I am sure other members’ offices) in the numbers that they have. I welcome a day when we do not have to put this sort of motion to parliament. I welcome the day that we do not have to remind the government to do its job. With those few words, I thank members for their support. Once again, I implore the government to extend its consultation on this to be more consultative, to be open, to actually explain what is going on and they might be surprised at the positive results. I commend the motion to the chamber.
Motion carried.
