I thank the AMA for the opportunity to participate in this event. A little over four months from now, South Australia will go to the polls. It will be an opportunity to set the direction for our State, not just for the next four years, but for many more years to come.
It is an opportunity to offer active reform in health to fulfil the potential of our State. That’s why – in March last year – two years out from the election – the State Liberal team released “2036” – a long-term vision for our State and a framework for the policies we have released and will continue to release up to polling day.
2036 is a vision that asks voters to focus on the future as we approach our State’s bicentenary and, importantly, asks what steps the next Government needs to take to deliver on that vision.
In terms of health, there are a range of challenges and opportunities. We need to move beyond the Weatherill Government’s focus on hospitals. We need to shift control from a centralised health bureaucracy to communities and clinicians. We need health services that act to maintain wellness - not just treat illness. We need health services that treat the whole person, with key investments to strengthen mental health services. We need health services that are sensitive to the diversity of our community.
In this brief presentation, I want to focus on four of the priorities a Marshall Liberal Government will take up. They are:
- preventive health,
- mental health,
- health reform and sustainability, and
- clinical governance.
Following the McCann Review, Labor defunded South Australia’s health promotion and prevention services, centralised primary healthcare services and failed to develop broad public health initiatives.
Labor thought it could ‘transform health’ by focusing on metropolitan hospitals. You can’t and it didn’t.
For every dollar invested in health promotion and wellbeing, more than five dollars can be saved in health spending – not overnight, but steadily and over time.
Communities and individuals must be informed and supported and, from time to time, steered into making healthy choices.
If elected in March 2018, a Marshall Liberal Government will support community-wide health and prevention services with the aim of reaching all South Australians.
This will be a multi-pronged approach that not only supports individuals and communities to make healthy choices but also provides the leadership and coordination to maximise partnership opportunities between every level of government and which reaches out to the non-government and business sectors.
An example of what this will mean at the local community level is the South Australian Healthy Towns Challenge that we announced back in June.
Under this initiative, South Australian country towns, in partnership with an NGO or university, will be able to receive funds for a preventative health project with measurable and immediate benefits.
At the macro level, we will establish “Wellbeing SA” as a Prevention, Health Promotion and Primary Health Care agency to lead and coordinate our work in this space. Wellbeing SA will be separate from existing hospitals and health services and able to advocate for and purchase services in public health and health promotion.
We will also establish the position of “Chief Public Health Officer” as a stand-alone role and require an annual report to Parliament on preventive health activity across South Australia and, in particular, across Government.
We need health services that treat the whole person. Mental Health is another key domain that has been mishandled by Labor. People marooned for days in hospital emergency departments waiting for a mental health bed. Older South Australians with severe dementia abandoned in the Oakden facility. People with mental health issues have been repeatedly failed by Labor. The Labor Government’s failure to plan services sets people up to fail.
In the run-up to the last election, Labor promised a five-year Mental Health Plan to cover the period 2015-2020. It has still not been delivered. In fact, the State’s last mental health plan expired in 2012. In the last five years, we’ve had four Mental Health Ministers but no mental health plan to drive reform and improve service delivery.
The team I lead is firmly committed to rebalancing the focus towards mental health, including the resources we invest.
Back in September, we announced our commitment to spend $10m over four years establishing a state-wide service for people living with Borderline Personality Disorder. Our plan includes:
- dedicated acute, outpatient and evidence-based therapeutic services for people with severe and complex BPD,
- ongoing and dedicated funding for a new mothers’ program with increased service delivery through Helen Mayo House, and
- a young people’s program to provide early intervention for people at risk of developing BPD or with early signs of BPD.
The day after we announced our $10m commitment, the Government responded with a paltry $1.2m over two years. Since then, it’s played catch-up.
It has matched our commitment and plans. But let’s be clear. This was not because it accepted that it needed to do much more in the BPD space. Instead, it was part of a trade-off deal the Treasurer cut with a cross-bencher in return for support for the proposed bank tax.
Aside from our BPD commitment, we have announced plans to establish a dedicated and well-resourced paediatric eating disorder service to address gaps in services for young people under the age of 15.
We have also committed to piloting an intensive outpatient drug addiction recovery program in the Riverland.
These – and other policies we’ll be releasing in the next few months – reflect our conviction that mental health is an integral part of overall health.
A Marshall Liberal Government will empower communities and clinicians through the establishment of metropolitan and regional boards of management across the State.
Under Labor, the number of people working in SA Health’s head office has exploded. Decision making has become centralised and frequently cut-off from the input of health professionals delivering frontline services and programs.
Our Board Governance policy will change that. If elected, we will implement major reform by decentralising the public health system through the establishment of 3 metropolitan and 6 regional boards of management.
Each board will be responsible for the delivery of health services within its region. It will appoint and manage its chief executive, control the health budget and actively engage with community and frontline health professionals.
We believe that Board governance will significantly reduce the wastage that all too often flows from excessive bureaucracy and poor project management.
Sustainability is a key challenge for the health system. The first step towards sustainability is sound management. Labor has failed to deliver. The new Royal Adelaide Hospital was delivered 17 months late and $640m over budget. EPAS is more than 3 years late and $250m over budget. Transforming Health was supposed to save $227m in its first two years – it ended up costing us an extra $47m.
The bureaucracy has more than doubled over the last ten years, adding cost and multiplying red tape. Fundamentally, a Liberal Government is committed to restoring sound management to health care. Boards of governance will be key – but even more important will be engagement with clinicians. You cannot improve the quality and safety of health care without engaging the clinicians who provide the care at the front line.
The future of the health system is primarily in the hands of clinicians. Supporting clinicians in Clinical Governance will be a priority issue for my government.
We saw in the chemotherapy dosing saga and the Oakden scandal, that sound clinical governance is fundamental to delivering quality and safe services.
The four reports into the chemotherapy dosing saga and the Oakden scandal all highlighted serious deficiencies in clinical governance in SA Health.
SA Health’s safety systems react to dangerous events rather than preventing them. Each stream of clinicians needs to make sure its house is in order in terms of clinical governance and collaborate with other professions. And government needs to give them strong support to do so.
Labor abolished clinical networks and the Clinical Senate and replaced them with Transforming Health working groups. We will work with clinicians and support them to deliver clinical excellence and sound clinical governance.
In conclusion, a Marshall Liberal Government will seek a relationship with health professionals that is founded on mutual respect and partnership.
Labor has disengaged health professionals. Labor has repeatedly denigrated medical practitioners. Labor has pit doctors against nurses. In contrast, a Marshall Liberal Government looks for a partnership.
We will need clinicians to work with us to deliver health reform – not a budget cuts program dressed up as health transformation. We want to focus on driving quality and safe health services. We know that better health services are more sustainable.
We know that investing in preventive health and mental health services will reap long-term benefits for both our State’s wellbeing and the effective management of our health budget. We know that you can only deliver better health services by effectively engaging the health professionals who deliver the care.
That is why a Liberal Government will have the priorities I have outlined this morning in:
- preventive health;
- mental health;
- health reform and sustainability; and
- clinical governance.