Motion, by leave, by Mr Whelan agreed to:

That standing orders be suspended to allow consideration forthwith of a no confidence motion in the Deputy Premier and Minister for Health, notice of which was given this day by the Leader of the Opposition, with the following time limits applying to the debate:

Mover 20 minutes
Deputy Premier 20 minutes
14 members 15 minutes
Deputy Premier in reply 20 minutes
Mover in reply 20 minutes.

Mr COLLINS (Willoughby - Leader of the Opposition) [12.59]: I move:

That this House no longer has confidence in the Minister for Health due to his mismanagement of the health system which has sent the system into crisis and plummeted staff morale to an all-time low in particular with reference to, but not limited to, the following matters:

(1) the cutting of $80 million in real terms from the 1996/97 Health budget;

(2) the cutting of 2,000 jobs including 900 nurses from the NSW public hospital system;

(3) the cutting of 500 beds from the NSW hospital system at a time when waiting lists are rapidly rising;

(4) the closure of St Vincent's Teaching Hospital, Darlinghurst;

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(5) the closure of Manly Hospital as an acute care hospital and its being turned into a psycho-geriatric centre;

(6) the closure of Rachel Forster Hospital, Redfern, and its attempted absorption into Royal Prince Alfred Hospital;

(7) the closure of 170 beds at Westmead Hospital, the busiest and biggest hospital in western Sydney;

(8) the closure of 160 beds at Concord Hospital which services veterans and residents of the inner west;

(9) the closure of Neringah Hospital, Wahroonga;

(10) the Minister's attempt to deceive the people of NSW into believing this is a redistribution of resources rather than a significant cut to the health system;

(11) the funding crisis created in the health system by his blind pursuit of the failed waiting list strategy;

(12) the decimation of country health services including the centralisation of the rural administration and rural job losses;

(13) the failure of the Minister to resolve the ongoing crisis in helicopter retrieval services; and

(14) the abandonment of at least five key election promises on health including:

(a) "Under Labor, no hospital will be closed"

(b) "500 extra beds will be opened"

(c) "800 extra nurses will be employed"

(d) St Vincent's, Darlinghurst, "Is assured of a future under this Government".

(e) Labor views that "Health is a core responsibility of the States. It should not be privatised".

The Carr Government is not about restructuring health services; it is about cutting health services. It will axe $80 million from the health budget at a time when the State can ill afford it. It will axe the jobs of 2,000 health professionals in the State. It will close at least 500 beds in the New South Wales public hospital system. And it will ensure the loss of one of the country's finest hospitals, St Vincent's Hospital, which is a teaching hospital with a worldwide reputation. The Government should hang its head in shame because it is about to destroy the public hospital system, which the coalition Government had to rebuild. When the coalition came to office in 1988 it set about rebuilding the public hospital system.

Mr Gibson: On a point of order. I reluctantly raise the point that the motion moved by the Leader of the Opposition is specific. It does not relate to what the Carr Government is doing, compared with what the previous coalition Government did.

Mr SPEAKER: Order! No point of order is involved. This is a wide-ranging debate.

Mr COLLINS: When the coalition came to office in 1988 it had to rebuild the public hospital system because the previous Labor Government had systematically destroyed it over the previous 12 years. And the coalition did rebuild the system! It is interesting that the Minister for Health claimed that the Labor Government would do something about beds for the west, because the coalition provided beds in the west. If the coalition had not come to office in 1988 Liverpool Hospital would not have been rebuilt as a teaching hospital at a cost of $190 million; Nepean Hospital would not have been rebuilt as a teaching hospital at a cost of nearly $100 million; the New Children's Hospital would not have been transferred from Camperdown to Westmead at a cost of $320 million; Gosford District Hospital would not have been rebuilt; and Wyong hospital would not have been rebuilt.

The previous Labor Government has only a litany of failures. If the coalition had not come to office, St George Hospital - a crucial hospital in the system - would not have been rebuilt as the fine teaching hospital that it is today. After a decade of neglect by the Labor Government, the coalition Government decided to turn St George Hospital into the teaching hospital that it is today at a cost of $200 million. What will the Carr Government do with St George Hospital? The Carr Government will give away St George Hospital and close St Vincent's Hospital as we know it today. St Vincent's Hospital is a medical icon in this country; it is a world-class hospital. When I took the decision as health Minister between 1988 and 1991 to rebuild St George Hospital - the sort of decision that this Government will never make - I based the hospital campus on St Vincent's Hospital, at a cost of $190 million, because it offers a major public hospital, a major private hospital, a major research facility - the Garvan Institute - a major consulting facility and a hospice on one site. St Vincent's Hospital has one of the finest campuses in the country.

What does the Carr Government propose to do about St Vincent's Hospital? It proposes to destroy the hospital by reducing the number of beds to only 100. The Government is attacking one of the finest bodies of medical expertise in the country by pretending that St Vincent's Hospital will be transferred to St George Hospital. At the end of the day how many extra beds will be provided at St George Hospital after the so-called transfer of St Vincent's Hospital? The answer is a mere 30 beds. The Government will destroy St Vincent's Hospital and dress it up as a transfer to St George Hospital. It will impose on St George Hospital a new administration - an administration not invited by the hospital. The matter was not open for expressions of interest or tenders. The Government is simply giving St George Hospital away. One can understand, to some extent, the pressure placed on the Sisters of Charity at St Vincent's Hospital in terms of the Government's decision. I refer to a press release dated 13 April 1995 and issued by the Minister for Health in the following terms:

Refshauge guarantees St Vincent's future.

The Carr Government today guarantees the future of St Vincent's hospital in the New South Wales public hospital system.

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The Government got the date wrong; it should have been 1 April, because it was another con job from the Minister for Health and the Carr Government. It is shameful that that commitment, given a year ago to the people of New South Wales and the administration of St Vincent's Hospital, has been comprehensively dishonoured. That should not come as a surprise. Labor's health policy document headed "Labor's plans for better health: Labor's vision", released just before the State election in March 1995 - about a month before the Minister's press release guaranteeing the future of St Vincent's Hospital, stated, "Under Labor, no hospital will be closed." Great lies of the century: "Under Labor, no hospital will be closed." Tell them that at St Vincent's Hospital. Take that policy out to Manly. Take that policy out to Rachel Forster Hospital in Redfern. Take that policy out to Neringah and try to tell them that under Labor no hospital will be closed.

The next point they made was "Hospitals will be built up." The Government is setting about tearing down hospitals, ripping down the great medical icons of this State, destroying specialist units built up over the years in some cases - in St Vincent's over 150 years. The next lie in the great Labor lies of the century is "500 extra beds will be opened." What Labor meant was 500 extra beds will be closed. A year later, under a Labor Government - the Carr Government - 500 beds will be closed. The next great lie in Labor's vision stated, "800 extra nurses will be employed." Well it appears that probably 900 nurses will lose their jobs as a result of the Carr Government's cuts to the health system.

The Government has systematically set about the destruction of fine hospitals. But it is not as if these services actually end up in western Sydney because the services do not move to the west. The Carr Government has cut resources to the west of Sydney, in the area from Parramatta to Liverpool to Penrith. One has to keep in mind that the Carr Government's Labor predecessors had absolutely no commitment to Nepean. In 1987, when I was the shadow minister for health, I visited Nepean Hospital. It had one ultrasound machine and there were 3,500 births per year at Nepean Hospital. That is why the Liberal Government rebuilt Nepean Hospital. This Labor Government is trying to ride on our coat-tails. The Government has done nothing. It has torn down what was already there. It has dismantled great hospitals. Far from gaining beds and jobs, this area will lose 120 beds and jobs.

Mr SPEAKER: Order! The member for Badgerys Creek and the member for Ermington will refrain from interjecting.

Mr COLLINS: I would like to see the member for Badgerys Creek have a conscience vote on this issue; she would have to be on this side of the Chamber, if she had a conscience. Westmead Hospital, the State's biggest hospital, has had its budget cut by $20 million. By saying that it is putting resources out to the west, the Government is lying. It is cutting $80 million out of the health budget, and will cut services the length and breadth of Sydney. It will cut 2,000 jobs from the system. Honourable members will remember what happened when 2,000 teacher positions were cut out of the education system. Wait and see what happens when 2,000 health jobs are cut from system. Watch the electoral consequences. How smug will Government members be about holding seats like The Entrance and Badgerys Creek when the blame is sheeted home to them and the Government they belong to? They should be ashamed to belong to the Carr Government, because it is presiding over the wholesale dismantling of this State's health system.

The Premier said there would be consultation: the Government has done the deal; it has announced it; and it has put out the little diagrams. The Government may have convinced a few people and may have got a couple of tame journalists here and there to swallow the line we are putting. The fact is the Carr Government is slashing the New South Wales health system to ribbons, and any patient or prospective patient in this State must realise that waiting lists will get longer, that waiting times will get longer, that the availability of services close to the people will get harder and, worse still, that specialist units, with expertise that has been built up over decades, will disappear overnight because of the destructive attitude of the Carr Government.

Older people in this State will well remember that the Wran and Unsworth governments set about the systematic destruction of other hospitals. They did it. They killed off the Mater public hospital. Right next to Parliament House, they tried to kill off Sydney Hospital. If there had not been a change of Government, Sydney Hospital would not exist today. Sydney Hospital would have been long gone. That is what Labor represents in this State. It represents settling old scores and getting even; that is what it is about.

The closure of 160 beds at Concord hospital is a betrayal of the veterans community of this State. It is a betrayal to the people of the inner west of this State. For Concord hospital to lose 160 beds is nothing short of criminal. For Rachel Forster to be absorbed into Royal Prince Alfred Hospital is to raise the risk of golden staph infection - a point made repeatedly yesterday by the medical and nursing staff of that hospital. They have a point and it has to be listened to. Of course, the Government will not listen to the medical experts. But the closure of 170 beds at Westmead indicates quite clearly the extent of the lie being perpetrated by the Carr Government in what is nothing short of a major downsizing of the New South Wales public hospital system.

What this Labor Government is about is slashing services. It will put at risk the jobs of 2,000 health staff who will be told to compete for their own jobs, to see how they go when their jobs
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are thrown open. Well, see how the people who work at St George go when they are told that their jobs are thrown open and that they have got to slug it out with displaced staff from St Vincent's Hospital! The Government has berated the Opposition in this House about the evils of privatisation, yet it is quite prepared to embark on what is the biggest privatisation ever undertaken in the New South Wales health system by the wholesale handover of an existing, fully operational and state-of-the-art tertiary teaching hospital, that is, St George, to St Vincent's administration, in an attempt to try to cover its backs, to try to cover the fact that it is really just about closing St Vincent's Hospital, getting rid of that hospital in inner Sydney. Yet, as later speakers in this debate will indicate, it is a hospital that serves the entire New South Wales. Because of its specialist services it serves people who come from the remotest parts of New South Wales to avail themselves of those services.

For the Labor Party to attack St Vincent's Hospital is utterly criminal. It is a disgrace! It is a blow from which the New South Wales health system will never recover. I want to place it clearly on the record that the coalition does not support axing $80 million from the health budget. The coalition does not support the downsizing of vital health services needed by this State. It does not in any way support throwing 2,000 health professionals out onto the health job market, where they may or may not get another job in New South Wales in a tough, competitive environment. The coalition does not, in any way, support the Government, nor does the New South Wales community. Tonight I will attend a rally at St George Leagues Club to try to preserve St George Hospital as it is and to try to preserve St Vincent's Hospital and the other hospital services that are under attack.

Dr REFSHAUGE (Marrickville - Deputy Premier, Minister for Health, and Minister for Aboriginal Affairs) [1.19]: What a pathetic performance! I thought the member for North Shore was bad news, but she should be leader after this. For goodness' sake, if the Leader of the Opposition wants to make an attack, he should at least show some credibility. The Leader of the Opposition and his successor closed 5,000 public hospital beds. That is what they did. Their last budget allocated $3,800 million for health. The first Labor budget dramatically increased that to $4,200 million. The Government's second budget further increased health funding to $4,380 million. I know members opposite tend to be illiterate; they are obviously innumerate as well. [Quorum formed.]

The final Collins budget, the only Collins budget, will be remembered for its devastating effect on the health care system; $3,800 million was the former Government's final health budget. This Labor Government's first budget had a dramatic increase to $4,380 million. I welcome back to the Chamber the Leader of the National Party. He walked out when the Leader of the Opposition was speaking. No wonder, he knew who to blame. The trouble is he still wants that trip to Atlanta, so if he did what he really ought to do - which is to vote with the Government - he would lose his position and would not get his trip to Atlanta. I welcome him back and I hope he will make some contribution to this debate. In two budgets the Government has increased the health allocation by 13.7 per cent, or $528 million. I welcome this debate because it highlights the significance of the changes made in health services.

This is the most significant equity reform to health care since the introduction of Medicare. For the first time the health dollar will be distributed equitably around the State. All patients, no matter where they live, will get their fair share. I know members opposite want only their electorates to get health services, but the Government has a responsibility, and I believe members of Parliament have a responsibility, to ensure equity for everyone in this State. The bandaid fixes of the past are over. The Government is breaking down the barriers to allow proper and fast health care where people live. Successive governments have championed equity in the health care system, yet no government has taken the most significant step, as is happening today. The Government is achieving equity in the health care system. For decades patients in Sydney's greater west, the Hunter, the central coast, the Illawarra and rural areas of New South Wales have been consistently denied their fair share of health resources.

Residents of central Sydney receive 1,152 health dollars per capita and have 5.1 beds per 1,000 of population. Residents of south-eastern Sydney receive 955 health dollars per capita and have 5.4 beds per 1,000 of population, and that is more than central Sydney. By comparison, Wentworth and the Penrith area receive only 509 health dollars per capita, that is, less than half of the amount allocated to central Sydney and just over half the amount for south-eastern Sydney. That is what the Opposition wants to continue. The Opposition does not believe in moving the taxpayers' dollars into the regions that pay the money. The Opposition is prepared to rob the regions, to keep the status quo, and deny those regions not only their fair share of taxpayers' money but their fair share of health resources as well. This is a most despicable act for the Opposition to oppose equity. I am sure all members of the National Party believe that the Government's moves are correct. Members of the National Party are closer to the people than the members of the Liberal Party are. The Liberals could not give a damn. All they are after is vested interests and making mischief on the way through.

The people of south-western Sydney receive only 471 health dollars per capita, even less than those in the Wentworth area, and that is almost a third of the amount received in central Sydney and
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certainly less than half the amount allocated to south-eastern Sydney. I will go through the bed numbers again: 5.1 beds per 1,000 in central Sydney; 5.4 beds per 1,000 in south-eastern Sydney; 2.6 beds per 1,000 in the Wentworth area; and 2.5 beds per 1,000 in south-western Sydney. Those figures say it all. Those figures say that for years these areas have been neglected. For seven long years the former government did nothing. Similar scenarios apply for the central coast, the Hunter and the Illawarra, as is clear when one looks at the important indicators in the health care system. Where are there delays in casualty - in the growth areas! Where is there delay in the development of community and mental health services - in the growth areas! Where is the lack of high-technology and superspecialty services - in the growth areas!

The Carr Government intends to end this inequity. The growth areas will benefit from a substantial injection of funds totalling more than $130 million. I now detail some of these benefits. The greater west will benefit from an injection of $33 million per year, starting this financial year. Changes in the greater west will include the following for Liverpool Hospital: an additional 240 beds; upgrading to teaching hospital status over the next two years; new and expanded services including cardiothoracic surgery, renal services, neonatal care, cancer services and an education centre. Nepean Hospital will receive additional funding for full commissioning of 120 beds; the hospital will be upgraded to teaching hospital status; and, for the first time, will provide a pain clinic and detoxification units. Hawkesbury Hospital will get an extra 40 beds.

The Hunter will receive a funding injection of $5 million for this year alone, which will allow the expansion of cancer services through the provision of an additional linear accelerator at the Mater Hospital in Newcastle. The final commissioning of new facilities at Maitland Hospital will allow it to operate at full capacity. The honourable member for Maitland supports this allocation. He definitely requires this hospital to be fully functional. In all conscience he ought to vote with the Government on this motion to make sure that this hospital is supported. If he does not, there is no doubt that his constituents will never forget that he voted against them getting their fair share.

The allocation of an additional $4 million commencing in the next financial year to the central coast will see the opening of additional beds at Wyong and Gosford hospitals, enabling expanded day surgery and obstetric services at Wyong and a new medical ward at Gosford. The honourable member for Gosford has criticised this. He will certainly feel the wrath of his electorate if he votes against getting those services. He either wants the services or he wants to play politics. I give him a chance; today he can vote on whether he wants those services. For the first time Wyong hospital will have the capacity to deliver surgical services around the clock. The Government is allocating extra funding to the Illawarra. The Illawarra regional hospital will be established as a full teaching hospital. It will also have closer links to St Vincents' Hospital. The expansion of cancer services through the commissioning of an additional linear accelerator at the Illawarra regional hospital will mean that cancer patients do not have to travel to the city for their treatment

What the people need is what the Government is delivering. I note the Opposition bleats on again, "Don't do it", but the Government will do it. The people pay their taxes, they deserve the services. I care about their cancer treatment, even if the honourable member for North Shore does not. The Government will also be expanding orthopaedic services at Shoalhaven hospital. There are bonuses for rural areas as well. An additional $15 million will be allocated to the rural areas of this State.

Mrs Skinner: Which is a joke.

Dr REFSHAUGE: The honourable member for North Shore says it is a joke!

Mrs Skinner: It won't pay off their debts.

Dr REFSHAUGE: She is a joke. Services in the bush need this money. That sum of $15 million includes $4 million for the mid-north coast area, $2 million for the greater Murray area, $2 million for the New England area and $1 million for the northern rivers area. The additional funding will deliver services to rural people and give them their fair share of the dollars. In view of major changes to the delivery of health services, it was necessary to ensure that comprehensive services to the south-eastern area were maintained. If the Sisters of Charity had continued to operate under the memorandum of understanding signed with the former Government and honoured by this Government - which they were quite at liberty to do - almost 200 beds at Kogarah hospital, 150 beds at Prince of Wales Hospital and a number of beds at Sutherland Hospital would have closed. If the Opposition does not want to amalgamate St Vincent's and St George hospitals, the appropriate capacity of three teaching hospitals will diminish and a number of beds will close.

Alternatively, the Opposition could do nothing, and send a message to Liverpool, Nepean, the bush, the Illawarra, the central coast and the Hunter that says: bad luck, the Opposition is not interested in you. The Opposition is bereft of proposals, suggestions and policies. When the Opposition was in government the only thing it did in the health area was close beds. On the Opposition's figures 5,000 beds were closed when it was in government and 30 hospitals were closed, wound down or privatised. What did the former coalition Government say when it closed Wallsend hospital? What did it say when it closed Kiama hospital? What did it say when it closed Glebe hospital? What did it say when it closed Marrickville hospital? What did it say when it closed Quandialla hospital? What did it say when it
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closed Binnaway hospital? When in government the coalition constantly closed hospitals, it constantly wound down hospitals and, if it could not do either of those things, it privatised hospitals, taking away resources to give to them to the private sector.

There is no doubt that the configuration suggested by the Government for south-eastern Sydney is the correct one. I find it offensive that the Leader of the Opposition was so uncharitable to the Sisters of Charity. I warn him that his actions and comments about the Sisters of Charity are very offensive to all who are associated with them, including me. The Government will not leave the people of Darlinghurst out of the picture. A hospital with medical and surgical beds and an accident and emergency centre will be available to look after their needs. I heard the bleating of the honourable member for North Shore, "You are not going to have enough accident and emergency centres." She should go to Liverpool and see what it does not have. She should go to Nepean and see what it does not have. The honourable member for North Shore is the hypocrite. She wants to keep everything locked up here, but she is not prepared to face the people of Liverpool and Nepean to tell them that she does not want to give them better hospital services. She is bereft of policies. She has air between the ears - nothing is happening in there.

It is a shame to see an Opposition so bereft of policies. It should at least attack the Government on some of the changes to make improvements to them, but all it is doing is saying, "No, leave everything here with the cappuccinos. We want to make sure that Stanley Street is looked after properly." The honourable member for North Shore goes to Stanley Street and thinks it is the western suburbs. The people of the greater west deserve a better Opposition. They are delighted with the Government because it is delivering to them. Significant changes will occur in central Sydney, which has been asked to contribute to health services in growth areas. Under the former coalition Government the greater west area received absolutely no capital injection. The only thing the former Government did in the west was close Western Suburbs Hospital and raze it to the ground. The former Government said that if it won the last election it would give the people of the greater west hospital services somewhere else.

Mrs Skinner: We started building the Innerwest Hospital.

Dr REFSHAUGE: The former Government did not start to build a thing. In fact, the former Government did nothing for the central west except close Western Suburbs Hospital. The Government has committed $272 million to upgrade the Prince Alfred hospital and the Concord hospital, which the coalition neglected for years. The Government is building them up, which will make them much more efficient hospitals and enable them to easily contribute to growth areas through the efficiencies generated from building new hospitals. The Government is also building the new Inner West hospital at Canterbury to deliver a district-level hospital for that community. It takes someone living at Kogarah 15 minutes or less to travel to Canterbury, but there is certainly no pressure on anyone to do so. I checked it; it is not a long way to travel. However, if a person living at St Clair or Leppington had to access health services, he or she would travel for much longer than that. I have heard the bleating from the honourable member for North Shore who says, "Keep it all as it is."

I can assure honourable members that the Government is moving services to the people. They pay their taxes, just as you and I do, and they deserve services. The Government will also use the old Western Suburbs Hospital site to build up aged-care services, which were ignored time and again by the former Government. I know these are tough decisions, but government is about being prepared to make the tough decisions and then deliver on them. The people of New South Wales want the Government to create imaginative solutions to the problems, to use taxpayers' money wisely to ensure they get the services they need. The Government welcomes the review of the committee that will consider alternative ways to ensure that services are delivered. The unions have been cooperative and have consulted in that regard. The Government will be happy to consider any suggestions from the unions that will produce a better clinical configuration within the parameters of delivering services to the west, the Illawarra, the central coast, the Hunter and rural areas, bearing in mind industrial issues as well.

When the former Minister faced a motion of no confidence he sought endorsements from significant people in the health care system. He got on his knees and begged people to write a letter of endorsement. Certainly not every decision he made was wrong; I suppose if one flips a coin, 50 per cent of the time one gets the call right. The Government has been flooded with support. It does not have to beg for support. The Dean of the Faculty of the Medical School of Sydney, Professor John Young, rang me and said, "Stick to it. We support you." Irene Hancock of the Australian Consumers Association supports this move. Dr Jane Hall from the Department of Community Medicine at Westmead supports the move. Rob Ramjam from the schizophrenia fellowship supports this move. Councillor Michael Neall, Mayor of the Blue Mountains, supports this move. Dr Rob McMahon, Chair of the Illawarra Area Health Service, supports this move. Professor Bruce Hall -

[Interruption]

I know that the Deputy Leader of the National Party does not like Bruce Hall, Professor of Medicine at Liverpool Hospital. He had better start listening to what is said. Professor Bruce Hall, Professor of Medicine at Liverpool Hospital, said, "This is the right way to go. Support this
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decision." Professor Steven Leeder, a former Minister for Health, supports this move. Tony Sansom, Mayor of Gosford, supports this move. Dr John McCallum, head of the health faculty, University of Western Sydney, supports this move. Professor Ian Webster supports this move. Francis Sullivan from the Catholic Health Care Association supports this move. Denise Fry of the Community Health Association supports this move. The Mayor of Wollongong and the Mayor of Liverpool support this move, as do the mayors of Maitland and the Blue Mountains and many others.

Mr Rixon: What is the call - for you to resign?

Dr REFSHAUGE: To move the beds to where the people are. The honourable member for Lismore has just woken up. I can tell him that his electorate gets money too. This is a vote of confidence in the health care system. [Time expired.]

Mr ARMSTRONG (Lachlan - Leader of the National Party) [1.39]: The debate can stop at this point because there is no doubt that the vote has been taken, in effect, judged by the support the Deputy Premier and Minister for Health has received from his own party today. I cannot remember the last time in this place when a Deputy Premier, defending himself in debate on a motion of no confidence, could not muster sufficient numbers to prevent a quorum from being called. Not only was a quorum formed, but Government members did not stay in the Chamber. Since the quorum was called for there has been an average of fewer than four members supporting the Deputy Premier in the House. He is condemned by his absolute rejection by his own party. They do not believe what he is doing will win favour with constituents throughout New South Wales. Government members will vote on the motion only because of party loyalties demanded by the Premier. They are not prepared to support the Deputy Premier of New South Wales. Their absence is an absolute rejection of him.

This afternoon the Deputy Premier quoted various people: from mayors to doctors to professors. But the people he did not quote are the average Joe Public, those who use the New South Wales health system. Why does he not talk to them to hear what they have to say? They are expressing themselves in rallies, in demonstrations, on television, and on talkback programs on radio. They do not believe this Minister; they do not trust him; they believe that their services are being taken away from them. The Minister for Health said this afternoon, "We are delivering." Clearly he is delivering uncertainty, confusion and removal of services. Nowhere is that removal of services more apparent than in country New South Wales. That is where this Government and this Minister, who has been rejected by his own party today, have put the knife through health services: country New South Wales. This is not about inner city spivs and the cappuccino crowd; this is about the salt of the earth country people who have been politically mugged at every opportunity by an uncaring and arrogant Carr Labor Government.

For scores of years St Vincent's Hospital has been the main referral hospital for many thousands of country patients. It has represented security, reliability, dependability and excellence to country people. Its removal from the heart of Sydney will be yet another withdrawal of valued services from country people. Already country people believe that the Carr Government treats them as second-class citizens. This latest move in regard to health services will only serve to emphasise that widespread belief in country New South Wales. The Government has done nothing to improve country health services. Country hospitals are generally understaffed and underfunded, and in many cases they face huge debts. Health rationalisation is simply not working. The decision-making processes have been taken away from regional health authorities and reorganised along political lines. This Government is running health on political lines instead of giving good health services to all the people of New South Wales; it has taken the word "local" out of local hospitals by reducing from 23 to eight the number of health districts in the State.

Centralising hospital administration in country New South Wales will destroy community support groups such as hospital auxiliaries and will cut off local service club funding. Whereas the coalition Government gave health control to local communities, the Carr Government has stripped away that control and caused further chaos in the State's health system. It is essential that country health services not be further eroded. The Government must set about restoring country health services to an adequate level so that country people can have access to services similar to those available to city people.

The Government has failed to take any action to overcome the shortage of doctors and nurses in country New South Wales. Every country city and town is desperately short of general practitioners. Doctors and health workers who choose to stay in the country are invariably overworked and under stress. No comprehensive plan exists to meet the doctor shortage and to fill vacancies in country practices. Hospital waiting lists have virtually become unmanageable and make a mockery of the promise by the Premier and the Minister for Health to halve them. The Government cynically chose December figures to claim that reduction had been achieved, knowing that December is seasonally a low period for hospital admissions and operations.

Many country hospital administrations were put under stress in trying to achieve unrealistic decreases in their waiting lists. It is a widely held view that an outbreak of golden staph infection in the Wagga Wagga Base Hospital could have been caused by the hospital's efforts to reach operating targets demanded by the Government. The
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Government's so-called rescue package of $4 million for rural health in March this year was little better than an insult to the 138 country hospitals in New South Wales, most of which are in financial crisis. The package failed to provide enough funding for hospitals to implement their infection control guidelines. In addition, the Government insisted that hospitals cut their maintenance budgets by 10 per cent.

The long hospital waiting lists, staff shortages and overworked doctors make it imperative that country people have access to reliable health facilities, such as the world renowned St Vincent's Hospital. St Vincent's paediatric facilities are particularly important to country children and offer a centre of excellence which is not conveniently available to them elsewhere. This access has become more important with the decision of the Government to place at least 90 per cent of New South Wales hospitals off limits to children under the age of five.

Following yet another extraordinary decision, the likes of which brand this Government as completely incompetent, children requiring surgery and an overnight stay in hospital cannot be admitted to a level 0-3 hospital except in an absolute emergency. Even in an emergency, they have to be transferred within 24 hours. This decision means young children will only be able to attend major rural base hospitals, provided those hospitals have a paediatrician in attendance. This decision was taken without consultation with country doctors or hospitals - another example of the arrogant disregard this Government has for country people.

As a result of that decision, for example, in my electorate a four-year-old Aboriginal child with respiratory tract problems who requires a drip for 24 hours cannot be admitted to Lake Cargelligo Hospital because of the Government's new guidelines on children in hospital. Instead, the child must travel for three hours to Wagga Wagga Base Hospital as just another admittance to an already overtaxed hospital. This ill-advised centralising of health services, which seems to obsess this Labor Government, is disadvantaging country people by downgrading local services and making it more difficult for them to have proper and reasonable access to health services.

The Rural Doctors Association is concerned that the changes to the system will lead to a loss of skills and incentives among country doctors, in particular the ability to administer anaesthetic to a patient when an emergency arises. The same concern applies to the future of the wonderful Royal Far West Children's Health Scheme whose funding arrangements are now under pressure from the State Government. The Far West scheme for many years has been a most important health facility for young country children. It is a non-Government institution which depends on donations and a Government contribution.

Until now the scheme has been classified as an autonomous institution which is self-run. But the Carr Government is planning to take control of the Far West scheme by placing it in the hands of the Northern Sydney Area Health Service, which has no knowledge or expertise in dealing with the health and welfare concerns of country people. This is nothing more than a blatant attempt by the Carr Government to get its hands on annual donations amounting to nearly $4 million upon which the Far West scheme depends. Over the past 72 years the Royal Far West Children's Health Scheme has developed a Statewide network of care for country children which is efficient, effective and without compare. A city-based health service has no right and no role to take over what is a very successful care institution.

The Government has no right to plunder far west finances and redirect those funds to other city health facilities. Country people are also extremely concerned about the future of CareFlight, which is experiencing a funding crisis and may be forced to curtail or cease its operations. Indeed, general confusion exists over the future of all airborne health services, such as the Royal Flying Doctor Service and its proposed base at Dubbo, and helicopter emergency and rescue services. There are rumours that a South Australian company may be used to replace existing services. Taken in its entirety, the Government has reduced the State's health system to chaos. Country hospitals are being downgraded, mental health services in country areas - particularly in the north-west, which has the highest incidence of youth suicide - are totally inadequate, and drug and alcohol programs are failing. In addition, funding to the Isolated Patients Transport and Accommodation Assistance Service - IPTAAS - has failed to meet the increasing demand caused by economic hardship in rural areas.

This is a health system in crisis - a crisis caused almost exclusively by the Government's lack of practical policy and its overall incompetence. The Minister must shoulder the responsibility for this appalling state of affairs, which has caused widespread public concern about health service closures, the centralising of those services and the downgrading of local facilities, all of which has been done without consultation with the public, nurses or doctors. Thousands of people will be disadvantaged, particularly country people, and hundreds of highly trained health workers will be thrown out of work, despite the Minister's mealy-mouthed assurance that they would be absorbed in new facilities. The public has lost confidence in the Minister's ability to properly administer an adequate health system in this State. Not only has the public lost confidence in the Minister, but members of the Government are not here to support the Deputy Premier. That is probably the most damaging indictment in modern memory, that the Deputy Premier cannot get party support during a motion of no confidence.

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Professional health staff have been betrayed, with some 900 of them facing the sack. Country people are being isolated from modern health facilities as never before. The New South Wales health system can only deteriorate further while this Minister continues to occupy his present position. The Minister could possibly restore some confidence if he were to give an absolute commitment to the upgrading of the New South Wales country health system: more general practitioners and midwives in country New South Wales; adequate relief for doctors in country areas; and equity in health care, irrespective of where patients live. Country people should not have a health service that by comparison with services in the city is second rate. They want a commitment to increased facilities, particularly on the north coast of New South Wales.

Mr ACTING-SPEAKER (Mr Gaudry): Order! I call the member for Murrumbidgee to order.

Mr ARMSTRONG: There has to be a commitment in real dollars, in bricks and mortar and in personnel, to accommodate the needs of the increasing population on the north coast of New South Wales. The Minister for Health should apologise to the people of country New South Wales for ignoring them and for trying to prop up his own political position. He should recognise that the people do not support him, because they have not been asked for an opinion and he would not listen anyway. That feeling is reflected in the lack of support for the Minister by members of the Labor Party. They will not support their own deputy leader! It is an indictment the likes of which has not been witnessed in living memory. The Minister is a disgrace. Who said so? The members of his own party.

Mr LYNCH (Liverpool) [1.54]: This is a very important debate about a very important issue. During such an important debate the Leader of the National Party should not inflict his mock indignation and histrionics on this House. I would have thought that he would have made a somewhat more substantial contribution to the debate than just engage in cheap tricks and absurdities as he has attempted to do. It is clear that the Leader of the National Party is treating the debate in a thoroughly frivolous manner and has absolutely no regard for the effect the changes will have on the people of western Sydney in general and the people of Liverpool in particular. To the constituents and residents of greater western Sydney this issue relates to equity and to privilege. It relates to installing equity into the health system and to the distribution of health resources and funding. It relates to the breaking down of the privileged areas of Sydney that receive far more of the health dollar than western Sydney receives. The people of western Sydney and Liverpool do not want second-best. They do not deserve second-best treatment; they deserve nothing less than the best.

Those who oppose the changes and support this motion are damning the people of western Sydney to second-best. They are saying that we are not good enough; that we do not deserve what the rest of Sydney gets. A number of ungracious souls would simply say that the Opposition is revealing its class nature. Members of the Opposition have shown what they really are: the silvertails. They are not necessarily members of the cappuccino society, although that has some relevance, but they have shown that they are silvertails; they have shown that they have no regard for the majority of the population in this city. If they go anywhere west of Strathfield, they are going on their annual holidays. To most members of the Opposition, Liverpool is a place they pass through on their way to the snowfields; it is not a place where real people live; it is not a place whose residents are entitled to a proper share of health resources. The current distribution of health resources and health dollars is thoroughly inequitable.

While it is perhaps unusual in this place to try to bring a few facts to bear on the subject, I will attempt to do just that. Firstly, I will refer to the medical staff distribution in area health services. The South Western Sydney Area Health Service region has 11.6 per cent of the State's population, but only 9.6 per cent of general practitioners, 6.7 per cent of specialists, 5.3 per cent of specialists in training and 5.3 per cent of non-specialist salaried staff. An examination of other health regions reveals a quite different set of figures. The north shore area of Sydney has 12.1 per cent of the population, 16.2 per cent of general practitioners, 16.6 per cent of specialists, 13.5 per cent of specialists in training and 14.9 per cent of non-specialist salaried staff. That shows, in fairly graphic statistical terms, the difference between the south-west areas of Sydney and the more privileged areas that are fighting so hard to prevent the proposed changes. Let me deal in broader terms with the greater western Sydney region versus the rest of Sydney. The western Sydney region has 26.8 per cent of the population - the rest of Sydney has 31.4 per cent; western Sydney has 23.7 per cent of general practitioners - non-western Sydney has 43.2 per cent; western Sydney has 19.8 per cent of specialists - non-western Sydney has 55.3 per cent.

Mrs Skinner: That has nothing to do with it.

Mr LYNCH: The honourable member for North Shore interjects to say that has nothing to do with it. This is the essence of it; this is about distribution of resources. This is about the Labor Party having the temerity and the hide to try to deliver to more people who deserve more. It is about the Opposition showing that they want it all.

Mrs Skinner: Who built Liverpool Hospital? Be honest.

Mr LYNCH: Who built Liverpool Hospital? The original plans were prepared under the last Labor administration but let us go beyond the building. If the Opposition's motion is successful
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today it will stop the process. The building will be wonderful but it will not have the 240 beds. The Opposition is attempting, by this motion, to leave a wonderful white elephant there. It is a very large building but the Opposition does not want it to have any beds, staff or recurrent funding. When it was in office for seven long years, the Opposition did absolutely nothing to allocate recurrent funding to staff Liverpool Hospital. The Opposition's motion is absolutely hypocritical.

I was saying before I was rudely interrupted that western Sydney has 19.8 per cent of the specialists and non-western Sydney has 55.3 per cent; western Sydney has 12 per cent of the specialists in training and non-western Sydney has 65.6 per cent; and western Sydney has 20.5 per cent of non-specialist salaried staff and non-western Sydney has 52 per cent. That is a graphic demonstration of the inequity in the distribution of health resources that is a result of the past seven years of conservative government. I draw to the attention of honourable members some other indices. In rough terms, greater western Sydney has half the population of Sydney. Western Sydney has only one of the six major teaching hospitals and two of the four smaller teaching hospitals.

South Western Sydney Area Health Service receives funding equal to about half the South Eastern Area Health Service budget and two-thirds of the Northern Area Health Service budget, notwithstanding the fact that all those areas have similar populations. Another example worth noting is that South Eastern Sydney Area Health Service has three cardiac services, whereas the greater western Sydney area has one. To use a more precise example, which came to my attention last year, magnetic resonance imaging machines, or MRIs, average about 2,500 uses each year. The Prince of Wales MRI has considerably fewer uses than that each year. Westmead MRI, the only MRI in a public hospital in Sydney's west, has 5,000 uses. That is an indication of the inadequacy and lack of facilities from which Sydney's west is suffering.

The inadequate distribution of resources is not, just at a theoretical level, a matter of what is fair and appropriate. It has real and direct consequences upon people who live in Sydney's west. It means two things: first, on a number of occasions people have to travel considerable distances for medical treatment; and, second - in some ways, even more frightening - a large number of people do not seek medical treatment. When new facilities are developed in western Sydney the number of people seeking treatment will increase. An example of that is Westmead children's hospital. The number of children seeking attention increased dramatically because services were provided in that area for the first time.

Another significant issue is the travelling time involved to obtain treatment. It is not just a question of inconvenience; it directly affects the health of people involved. A person with a serious condition living at Liverpool who has to travel to the city for treatment would have about 1½ hours of travelling time each way. The treatment, which might take two or three hours, has to have added to it another three hours of travelling time - three hours in which the patient is not recuperating, resting or getting over the condition from which he or she is suffering. So this is not just a simple, easy, matter about convenience; it is a significant matter about the health of people suffering from illnesses. Professor Bruce Hall, who has been referred to on a few occasions today, said in a letter to the Sydney Morning Herald:

This contravenes a WHO recommendation that medical services for many chronic diseases should be within 20-30 minutes of the patient's residence.

That means in a real sense that south-western Sydney does not measure up to the World Health Organisation recommendation; we are not conforming to well-recognised standards of treatment. The Opposition supports the proposition that south-western Sydney does not measure up to WHO recommendations. The Opposition wants to condemn residents of south-western Sydney to a third world medical system. Members of the Opposition are saying that we are not allowed to catch up; we are not allowed to make up the difference; and we are not allowed to comply with the WHO recommendation. The Opposition is saying that people in western Sydney have to keep travelling more than 20 or 30 minutes for treatment for chronic conditions. As I have said, this is an indication of the silvertail nature of Opposition members, who completely disregard and have contempt for the people of Sydney's west and south-west.

Mrs Skinner: Who built the hospitals?

Mr LYNCH: The only knowledge the honourable member for North Shore has of Liverpool is that it is somewhere through which she has to travel to go somewhere else. It may well be that we are delighted for her to keep going and never come to Liverpool, but that is an indication of her lack of understanding and knowledge of these important issues. The funding and distribution inadequacies were referred to by the Minister for Health when he made an announcement last Friday. A significant number of actions have been taken to attempt to rectify the maldistribution. Liverpool Hospital, which is to get an additional 240 beds, will be upgraded to teaching status. It is all very well for the former Government to have built the hospitals, but at least now someone will provide the beds. That can only be done in accordance with the Government's proposals. The intensive care unit at Fairfield District Hospital will be upgraded and paediatric services at that hospital are being improved.

Additional funding will be allocated to Nepean Hospital to fully commission 120 new beds. Nepean Hospital will also be upgraded to teaching
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hospital status and a pain management clinic and detoxification unit will be established there. An additional 40 beds will be made available at Hawkesbury Hospital. Improvements will be made to hospitals in the greater western Sydney area, at the Blue Mountains hospital - a matter about which other honourable members will speak at length later. The Government is providing money in the areas where health services and beds are needed. People will no longer have to travel to obtain health services. These changes were well and truly flagged last year. It staggers me that people are complaining about a lack of consultation.

Mrs Skinner: Are you attacking the union now?

Mr LYNCH: I suggest to the nurses who are angry and upset about what has happened that they should direct their anger at the right-wing leadership of their union. The union leadership should have been as conscious as I was of the changes announced last year when the resources allocation formula was changed to the resources distribution formula. Those changes were extraordinarily well publicised. The changes announced by the Minister last Friday inevitably flowed from announcements made last year. Anyone who did not know that did not read what was written or listen to what was said. Clearly, Opposition members, together with the silvertail elements opposing these changes, stand condemned because they did not know what was happening last year. It was obvious that this was going to happen. Anyone who studied the issue and who did not understand it must have considerable difficulty with his or her level of comprehension. I draw to the attention of honourable members what Bruce Hall, a professor of medicine at the University of New South Wales, located at Liverpool, had to say:

The Government is right. It is time for nurses, allied health and medical professionals to relocate to the communities of limited health services.

The taxpayers of South-Western Sydney have not got their fair share of the limited health budget.

Now is their chance to improve their access to fundamental health services that those in the inner city have enjoyed for many years.

Mrs SKINNER (North Shore) [2.09]: Only 19 months ago the Deputy Premier, Minister for Health, and Minister for Aboriginal Affairs described our health system as the envy of the world, with our hospitals providing stunning options. Media reports now carry the headlines, "Health crisis. Hospitals in disarray and staff betrayed." Do we have confidence in a Minister who has caused such a dramatic and shocking turnaround? How does the Minister's record rate with the people of New South Wales? The Minister, who is in the Chamber, turns his back on this part of the debate because he cannot stand to hear the truth. Do patients in this State have confidence in the Minister? Does Mrs Morrison, who has been a patient at Rachel Forster Hospital for 18 years, have confidence in the Minister? I spoke to her yesterday as she sat in her dressing-gown outside that hospital with tears in her eyes. She begged me to try to do everything I could to save her hospital.

Do doctors have confidence in this Minister? Dr Paul Stalley, who addressed a rally, accused the Minister of "either poetic licence or ignorance" when the Minister suggested that the beds at Rachel Forster Hospital to be moved to Royal Prince Alfred Hospital would be hermetically sealed and therefore protected from perilous infection and then revealed that patients would have access to the intensive care unit at Royal Prince Alfred Hospital. Dr Stalley said that he would rather not do joint replacements in such conditions, in which infection could lead to another replacement. Do nurses and other hospital staff have confidence in the Minister for Health? Sandra Moait, the New South Wales Nurses Association General Secretary, has told rallies of staff at St Vincent's and St George hospitals, which I have attended, that they have been betrayed and that the Minister is completely out of touch with the health system - those were her words.

Mr Mills: She has never been out of inner Sydney.

Mrs SKINNER: The honourable member for Wallsend says that Sandra Moait, the General Secretary of the New South Wales Nurses Association, has never been out of Sydney. That comment will be recorded in Hansard, and I will send it to Sandra Moait and the Nurses Association. It is a demonstration of the Government's lack of regard for the nurses who work in the system. Since coming to office, what has the Minister for Health done to the health system which he once described as the envy of the world? He has orchestrated a waiting lists figures swindle that is breathtaking in its dishonesty. Claims of reduced waiting lists have been disproved by the waiting lists, which are now longer than they were when the Carr Government came to office, rejected by the Opposition and the New South Wales branch of the Australian Medical Association and repudiated by evidence to the Select Committee on Hospital Waiting Lists.

The promise to halve hospital waiting lists - made to buy votes - cost around $200 million, according to Professor Stephen Leeder, Director of Public Health and Community Medicine at Westmead, who under oath gave evidence to that effect to the Select Committee on Hospital Waiting Lists less than two weeks ago. The Minister was very happy to quote Professor Leeder on another matter. He should listen to the professor's statement that the Government's waiting list scheme, its fraud of a scheme, cost $200 million. Since the Government provided only $80 million for the scheme, where did the extra money come from? It came from the budgets that hospitals were given to provide emergency care, dental treatment, colonoscopies, endoscopies and cardiac
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catheterisation and to deliver babies. What was the source of the $100 million that it cost to implement infection controls, since the Minister made no additional allocation to cover his legislation in this matter? It came from the same area, from hospital budgets. That is why hospitals and the health system were $72.8 million in the red when the Treasurer presented the budget in this place in May.

The figures came as no surprise, after regular reports of hospital budget blow-outs, and they have increased, despite unrealistic demands by the Minister to claw back hospital budget blow-outs. None of this is news, because it has been making headlines for months. The final straw came on Friday with the announcement of the Minister's final blow, disguised in fancy, glossy brochures and fake claims of fairer resource distribution. I pity the Labor mates that the Minister wheels out to fling insults of "silver spoon" at hard-working staff and desperate patients who are shattered by the dismantling of major hospitals. I pity them, because the light will dawn when they realise that this is not about redistribution or reallocation of resources; it is about cuts.

[Interruption]

Government members are worried about the message I am giving them from the people of New South Wales on the Government's total mishandling of health. A sum of $80 million has been cut from the health budget, 2,000 jobs will be lost and 500 beds will be closed. The Minister's glossy publication entitled "A Better Service Network for NSW Health" has been scoffed at by rallies of the nurses union. The Government's false claims start on page 1 of that publication, where it is stated:

Following extensive consultation, the Government is now ready to start implementing its package of reforms in the areas of equity in resource distribution, incentives for Area Health Services to get best value for the health dollar and improving the quality of services.

Even the Premier does not agree with the Minister's claim about extensive consultation. After a one-and-a-half hour meeting with the unions the Premier agreed to four weeks consultation, after the event, when all the decisions had been made - decisions that the Minister told Alan Jones on radio yesterday morning he would not be changing, despite the Premier's consultative committee. So much for the Carr Labor Government's compassion and interest in change! The Minister turns to have a chat with Government members every time he does not want to hear what I am saying - my speech is making him very nervous.

I turn to the matter of equity of resource distribution. What is equitable about shifting money from some areas but not moving an equivalent amount to others, the so-called winners? The total "loss" for the so-called losers - south-eastern Sydney at $52.8 million, central Sydney at $30 million, northern Sydney at $20.2 million and western Sydney at $20.6 million - comes to $123.1 million. The total gain to the winners - the Illawarra at $7 million, the central coast at $4 million, the Hunter at $5 million, Wentworth at $13 million and south-western Sydney at $20 million - comes to $49 million.

Mr Mills: Keep going, you've left out the bush.

Mrs SKINNER: I will come to the bush. So far a sum of $74.1 million is missing. The bush gets a $15 million rescue package - $1 million to Northern Rivers, $4 million to the mid-north coast, $2 million to New England and $2 million to the Greater Murray. An amount of $6 million is thrown in to pay off the 1995-96 debts. There is a total loss to the system of $59.1 million. Those are the figures in the Minister's glossy document, figures that he has published. Maybe the Minister's bureaucrats have made a mistake in the figures, like they made a mistake about closing the psychiatric unit at Westmead Hospital. Perhaps the Minister should discipline someone about the errors in his document. If the Minister adds up the figures again, he will find that some of this money, some of the beds and some of the staff members are being lost on the road to the growth areas of the greater west of Sydney.

Is the financial cut to the health system fair and equitable? It will not go anywhere near paying off debts such as the $15 million debt at Westmead, $7 million in the Illawarra, $4 million at Wagga Wagga and $2 million at Tweed Heads, let alone provide for expansion of services. The resource distribution is about cutting $59 million from area and hospital budgets. It is about cutting jobs and closing beds. The greater western Sydney area - the area that the Minister claims to be the great beneficiary - is to lose 120 beds and 40 jobs. What is equitable about closing down St Vincent's Hospital at Darlinghurst, leaving 100 of the current 360 beds to cope with the particular needs of the local community, which are very demanding needs, and the needs of many patients who come from the country because they like the specialist care provided by the hospital at Darlinghurst, which was established in 1857 by the Sisters of Charity and has been at Darlinghurst since 1870?

The role of St Vincent's public hospital is ". . . complemented by close relationship with five other facilities on St Vincent's Health Care Campus" - a term quoted from the annual report. The facilities are complementary in that they work together on the campus at Darlinghurst. The Minister, with one swoosh of his pen, is moving the hospital to Kogarah, which is, I might add, hardly a growth area of the State. What happens if there is an unforeseen catastrophe in the city? Much has been made about the Opposition's supposed lack of concern for people. It is extraordinary that the Government has no concern for the one million people who work in the city of Sydney every day. Is it expected that ambulances rush trauma patients to Randwick, to the Prince of Wales Hospital, where the new women's hospital remains empty
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because this Minister will not have operating theatres ready for two years and where the goods and services budget is shot to hell because it has received no extra money for infection control measures?

Ironically, only last Friday, at the time that the Minister locked a selected few away to inform them of his dramatic changes, ambulances broadcast that they were to bypass city hospitals, which were for life-threatening cases only. Is that equitable? Is it equitable that the Minister is forcing St George Hospital effectively to close? Is it equitable that the locals are to lose their sense of identity with that hospital? Tagged the "chicken wire hospital" when the Greiner Government came to office because it was literally held together by chicken wire, St George Hospital is now the most sought-after posting for graduating doctors. I am sure that one of my colleagues will go into a great deal more detail about St George Hospital later on.

What does the Minister say about the fact that people learned through media reports last Friday, despite denials that services would remain, that Manly District Hospital was effectively to close, that it would become an aged-care facility and would lose obstetrics, gynaecology, ear nose and throat and orthopaedic services? What about the staff and patients at Neringah Home of Peace Hospital at Wahroonga? Another of my colleagues will talk about that particular matter. I was at Neringah hospital by the bedside of one of my oldest and best friends on 15 May 1988 when she died. I visited her many times and was impressed by the individual care, the quiet and dignity shown to a dying patient. The palliative care and rehabilitation services of the 70-bed Neringah hospital are a scarce resource, and their loss by closure is an absolute crime. So is the loss of the Rachel Forster Hospital, which is supposedly to be moved to Royal Prince Alfred Hospital and remain intact.

Rachel Forster Hospital is the only public hospital left in New South Wales specialising in bone and joint treatment. The fear of cross-infection through its relocation to Royal Prince Alfred Hospital has already been described. I wonder whether the people associated with Concord hospital feel that this is an equitable arrangement. Concord, the Olympics hospital, is to lose 160 beds and 540 staff. I visited Concord hospital just recently. I was impressed not only with the hospital but with its General Manager, Alan Kinkade. He had a vision, commitment and care for that place. Last Friday Alan Kinkade was summarily removed as general manager. He was told to report to Prince Alfred and that its general manager would become the group general manager for the amalgamated Royal Prince Alfred Hospital.

I shall speak briefly about some other matters that I am sure will disillusion the people of the so-called growth areas. The Illawarra area, which gains $3.3 million, already is "in receivership", with a budget blow-out of $7 million. The Wollongong Hospital loses 50 jobs in this deal, as it tries to deal with its debts. Hospitals in south-western Sydney which have already been upgraded by the coalition will now have to cope with patients seeking refuge from closed doors at other hospitals. The funding for the central coast and country New South Wales will not go anywhere.

I demonstrate my concern following a visit that I made to Tweed Heads District Hospital recently. That hospital, which serves one of the fastest-growing areas in the State, has current debts to the tune of more than $2 million and a price tag to open beds of more than $5 million. What was its response to the Minister's announcement? "Gloves are off" said the Daily News of 27 June - "Doctors have gloves off in the health battle". They are not satisfied. They are not happy. Another matter that concerns me is case mix budgeting. Areas that are to lose resources are issuing instructions to hospitals to restrict beds in specialties where patients stay longer than the State average. [Time expired.]

Mr MILLS (Wallsend) [2.24]: It is with great pleasure that I speak in this debate and oppose the no-confidence motion - a rambling motion moved by the Leader of the Opposition. But this is a very serious debate, the most serious that could be held in this Chamber, and it needs to be taken seriously. I am pleased to speak to the motion because I believe that what was announced last week was one of the most far-reaching changes for the overall benefit of the people of New South Wales to be made in a generation. In the past the people of the Hunter have been given a raw deal on the delivery of health services. I am glad to say that with the Minister's decision the days of the raw deal are over. For years the Hunter has been underfunded and underresourced in health care. As a consequence, an increasing number of Wallsend constituents have been forced to travel to Sydney to get the medical care that they need. In 1994-95 more than 2,500 constituents of the members of the greater Newcastle and Lake Macquarie area were forced to travel to Sydney for basic health care. That was nothing short of a gross inequality.

With the decision announced by the Minister last Friday that inequality will come to an end. For the first time, services needed by the people of the Hunter will be provided in the Hunter. Because of that decision a fully staffed linear accelerator will be installed at the Newcastle Mater Misericordiae Hospital later this year. Because of that decision Maitland Hospital, when commissioned and opened, will be able to operate at full capacity. But, more importantly, for the first time the people of the Hunter are on their way to being treated as equals in health funding and not as second-class citizens. The Hunter area will receive $5 million in the coming financial year and in every year thereafter. We expect that the level of underfunding will be reduced over the next three years, that services will be expanded and brought up to the same level as services enjoyed by residents of inner Sydney areas.
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This is a great decision not only for the Hunter but for the whole of New South Wales. I have pleasure in commending the Minister for that decision.

One has only to look back over the seven long years under the Liberal-National governments in this State to realise the hypocrisy of today's no-confidence motion. It is all very well to debate this issue, but to bring it on as a no-confidence motion shows the hypocrisy of the Liberal and National parties in the Parliament. As we heard the Premier say at question time, in the seven long years of coalition governments 30 hospitals closed and 22,000 beds in the public health system were reduced to 17,000 beds, that is, 5,000 beds were closed. And coalition members have not learned yet! Last Thursday in the Parliament, while the Minister for Health was answering a question about ambulance services in the Hunter, the honourable member for North Shore, and Opposition spokesperson on health interjected and said, "Don't worry about the Hunter". I thank the honourable member for North Shore for that interjection. We now know - as, of course, we knew all along - that the Liberal and National parties did not care too much about the Hunter when it came to health services. They maintained underfunding in the Hunter for a long time.

Today we have heard some very interesting figures as to why this scale of redistribution of health resources was necessary. More than 9,000 patients per annum have been coming from the Liverpool area to the Westmead Hospital; 10,000 patients per annum have been coming from the Nepean area to Westmead Hospital; hundreds have been coming from the Hunter to Westmead; hundreds have been coming from the Illawarra; and hundreds of patients have been coming from the Hunter to Royal Prince Alfred Hospital and other Sydney hospitals. As I said before, in 1994-95 about 2,500 of my constituents were forced to travel to Sydney for health care.

We have heard from the Leader of the Opposition and the Opposition spokesperson on health a litany of negatives, but by and large they ignored improvements in health services. This is a real redistribution. I want to list those improvements for the record. The honourable member for North Shore did not give the full list. The improved services include Liverpool, with an increase of 240 beds; Nepean, an increase of 120 beds; Hawkesbury, an increase of 30 beds; and the combined St Vincent's Hospital, Kogarah, has an increase of 100 beds. In the near future the Prince of Wales Hospital will have an increase of 300 beds, so we cannot really have any serious carping from the eastern suburbs of Sydney about their health services. The Darlinghurst site will keep 100 beds. In Wyong and Gosford there is an increase of 34 beds.

Those were only the improvement in the numbers of beds. But Nepean Hospital is being upgraded to teaching hospital status. The Illawarra regional hospital is upgraded to teaching hospital status. That is terrific news for those growth areas of New South Wales. We are seeing the rebuilding of Kiama District Hospital. A second linear accelerator is to be located in the Illawarra so that the people of the Illawarra can receive their treatments closer to home. There is to be a new medical ward at Gosford District Hospital. I wonder which way the honourable member for Gosford will vote on this motion. Will he be hidebound by his party discipline? Will he try to pretend that the central coast will not benefit from the redistribution of health services? Day surgery and obstetric services at Wyong hospital are being expanded. As I have previously mentioned, there will be full capacity for Maitland Hospital upgrading when that hospital is opened. There will be a fully staffed, new third linear accelerator at the Newcastle Mater Misericordiae Hospital.

Further, in the retained 100-bed hospital at Darlinghurst on the old St Vincent's site, this Government will retain the emergency department. I contrast that with what happened under the Liberal Government and how some nine months before the closure of Wallsend Hospital the Liberal Government closed its accident and emergency department. After Wallsend Hospital was closed, in spite of promises given at the time of its closure, the emergency department of Royal Newcastle Hospital was also closed. When the previous Government was in office the Hunter region lost two hospitals, yet this Government is doing the right thing by inner Sydney and the eastern suburbs by retaining the emergency department on the St Vincent's Hospital site.

South-western Sydney Area Health Service will receive $20 million this coming year and more next year. This is a redistribution of resources in a real way. Wentworth Area Health Service will receive $13 million-plus; Central Coast Area Health Service $4 million-plus; the Illawarra $7 million-plus; Hunter Area Health service $5 million-plus, and the Mid North Coast Area Health Service $4 million-plus. I wonder how the members for Port Macquarie and Myall Lakes will vote on this no- confidence motion. Will they be hypocritical and pretend that their region will not receive for the first time ever its share of funding? I could not understand why the Leader of the National Party pretended that rural New South Wales will not benefit from this redistribution. He is ignoring the facts. He is so besotted with inner city health issues, which was evidenced by his question today -

Mr Crittenden: That is where he is retiring to.

Dr Refshauge: He can join the cafe latte set.

Mr MILLS: He can come along to the Palati Fini restaurant with me next Christmas. The Leader of the National Party failed in his pretence that rural New South Wales is not benefiting from this distribution of funds. The Hunter, Liverpool, Nepean, Illawarra, mid north coast and central coast
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will, for the time, receive an equitable share of funding. That is what social justice is all about; it is one of the fundamental principles of the Labor Party, which is why it was elected to office last year and the Liberal Party-National Party Government was thrown out. The Greater Murray and the New England area health services will each receive $2 million-plus; Northern Rivers Area Health Service will receive $1 million-plus and $6 million for the rural rescue package. A total of $64 million will be redistributed to growth areas for improvements, justice and equity.

Alex Sanchez was right yesterday when he characterised the opposition to this restructuring package as being led by spivs, inner city trendies and the cappuccino set. It needed a spark of some sort to capture the imagination and he really got it right. The areas that will for the first time in living memory receive justice in health funding will now start to fight back; and the people who see the old medical empires of the inner city as the only health service will be isolated. The health service is widespread. The Government's objective is to invest money where the people live and it will achieve that purpose. Thank you, Minister, on behalf of the people of the Hunter for having the courage to do that.

There has been some talk about chronic underfunding of health services in the Hunter. For the past 20 years successive governments of both political persuasions have not provided sufficient enhancement funding as badly needed services were gradually established in our region after the medical school started in 1976. The consequence was that hospital staff and budgets were always under stress. Many patients had to travel to Sydney for treatment. For example, it was easier to get a bed at Royal Prince Alfred or Westmead hospitals for, say, cardiac surgery than it was at the Hunter. The Hunter had 8.7 per cent of the population but received only 8.4 per cent of health funding. That has been the basis of our claim for many years that we were underfunded by about $15 million or $20 million. We did not get our per capita share.

Dr Refshauge: It is coming.

Mr MILLS: Thank you, Minister. This underfunding was widely acknowledged by Mr Collins and Mr Phillips when they were Ministers in the coalition Government. The present Government has acknowledged it and is doing something about it. In support of the redistribution of health services the Mayor of Maitland, John Martin, issued a press release which reads:

"Maitland people will benefit from the realignment of health care services funding in NSW towards growth areas. . ."

Maitland Hospital is to have its new facilities commissioned to allow operation at full capacity. Councillor Martin said, "it was good news for patients from Maitland and the lower Hunter area who will have a better chance of getting their treatment closer to home."

He said further:

"This expansion of health services in the Hunter should be supported and encouraged by our local State Member, Peter Blackmore."

Planning for the upgrading of Maitland Hospital was started when Allan Walsh was the sitting Labor member. It continued under the coalition Government with its Liberal member Mr Blackmore. The process is being completed now under the Labor Government and Minister Refshauge. Well done, Minister. Mr Blackmore should be honest and welcome the benefits to his electorate by voting against this no confidence motion. In a press release the Lord Mayor of Newcastle welcomed the additional funding as follows:

The additional $5 million to be injected into the Region's health budget will provide service to the ill and employment in a region suffering deficiencies in both areas, the Lord Mayor, Councillor Greg Heys said. . . .

"We understand that inner-Sydney areas will face some pain through the loss of funding because we have been through many such painful years. We remember well the closure of Wallsend Hospital and the sacking of the Area health Board by the Greiner Government."

Councillor Heys said that he was particularly pleased that the funding boost would allow full staffing of the third linear accelerator at Newcastle Mater Misericordiae Hospital.

To the nurses and medical and general staff of inner Sydney public hospitals that will be affected I say this: Lots of us patients have had no choice but to travel long distances to your inner Sydney hospitals for treatment. You had our beds. You had our health money. You have done a great job, but the system required our sick people and their carers and families to travel a long way to you. Lots of people from our region have had to go to your hospitals to work. Please come out and work in the regions were we all live. You will find that we will make you very welcome. This equity funding distribution will benefit patients in the Hunter and other regions.

Mr PHILLIPS (Miranda - Deputy Leader of the Opposition) [2.39]: If there were any greater justification for passing this no-confidence motion in the Deputy Premier, Minister for Health, and Minister for Aboriginal Affairs today it would be the lies that have been told in this Parliament. I ask the honourable member for Wallsend and other members on the Government benches to look past the scraps that they have been handed out in their areas, as part of a program of redistribution that has been going on for years, and look at what is happening totally in the health system. If, as the Deputy Premier said today, this was about moving services to where the people are, Opposition members would support him all the way. That would be expanding the programs that started in earnest under the previous Government since 1988. Opposition members are extremely proud of the contribution they made to the large number of hospitals built and rebuilt in areas of Sydney and country New South Wales. However, if one
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ignores the rhetoric and looks at the facts contained in the Government's documents one will see that this announced program is about cuts and has very little to do with the movement of resources to where people live. The editorial in this morning's Sydney Morning Herald, under the heading "Sick beds on wheels", said:

The NSW Opposition's spokeswoman on health, Ms Jillian Skinner, has accused the Government of "surrendering to beancounters and bureaucrats" in announcing its shake-up of hospital services. It is difficult to accept such a simplistic comment is endorsed by the Opposition Leader, Mr Collins, the Deputy Opposition Leader, Mr Phillips, or the Opposition Leader in the Legislative Council, Mr Hannaford - all of whom are former health ministers.

All we former health Ministers agree that redistribution is fine but that this program of cuts is absolutely unacceptable. Again, journalists from the Sydney Morning Herald and other newspapers should look past the rhetoric and at the facts. The facts are that there is a cut of $80 million from the 1996-97 health budget and the Government has to cut services now to stop the system haemorrhaging during the next financial year. The bureaucrats, the pencillers from Treasury, have said to staff of the Department of Health that it has to cut $80 million from its budget. That is what this program is all about and it has nothing to do with the shifting of resources.

The Government will cut 2,000 jobs, 900 nurses and 500 beds from New South Wales hospitals. For the Government to talk about redistribution of western Sydney is fine, but 500 beds will not be provided; 500 beds will be lost from the health system. The Government will close one of the most highly regarded teaching hospitals in the world, St Vincent's Hospital. That will achieve a big saving. The Government will close Manly District Hospital as an acute care hospital and turn it into a psychogeriatric centre; and it will close Rachel Forster Hospital. When I was Minister for Health I heard the line from the bureaucrats: transfer the services at Rachel Forster Hospital to Royal Prince Alfred Hospital, close Rachel Forster Hospital, and then after a period of time consolidate them into one hospital. The department tried to sell the same line to me.

Staff at Rachel Forster Hospital know of the importance of having that specialised orthopaedic centre separated from a normal hospital because of the high risk of infection and disease. That is what the Government should do with the Rachel Forster Hospital; that is what the former Government was doing. The Government will close 170 beds at Westmead Hospital, the biggest and busiest hospital in western Sydney. The Government says it is distributing resources to the west and yet at Westmead Hospital, the biggest teaching hospital in western Sydney, 170 beds will be slashed. The Government will close 160 beds at Concord Repatriation General Hospital, which I thought was in the inner-west; I did not know it was on the coast or in the centre of Sydney. The Government will close Neringah hospital at Wahroonga.

The Minister has attempted to deceive the people of New South Wales into believing that this is a redistribution of resources rather than a significant cut to the health system. If this is a movement of resources to the greater west of Sydney, can the Government explain why in this so-called redistribution the greater west will lose 40 staff and 120 beds? If one takes the western Sydney area, the Nepean and the south west, which covers the greater west of Sydney, there will be a net loss of 40 staff and 120 beds. The Government is attempting to con the people of New South Wales and the Opposition that it is moving resources to the west, but that is just not true; it is a blatant lie. The Government should check the documents that the Minister for Health has issued. The Minister for Fair Trading, and Minister for Women says, "I have got a few beds in my hospital. I'm alright". But she should look at what the Minister for Health is doing to the total health system; it is an absolute disgrace.

Key election promises of this Government have been thrown out the door. For instance, "under Labor no hospital will be closed" - that is out the door, gone; "500 extra beds will be opened" - "opened" was wrong, because they are to be closed; 500 beds are now closed, so there is a total loss of 1,000 beds in broken promises; "800 extra nurses will be employed", but 900 nurses will be cut from the health system. I can understand rationalisation of beds and movement of resources, but cutting the number of nurses by 900 is indefensible. In its election campaign the Government said, "St Vincent's Darlinghurst is assured of a future under this Government." That is another promise that has gone out the window.

The Government said that in Labor's view "health is a core responsibility of the States. It should not be privatised". Yet St George Hospital, a $500 million brand spanking new, international standard, state-of-the-art hospital, is given to the Sisters of Charity. The Sisters of Charity do great work at St Vincent's Hospital but it is inexplicable that the Government has given St George Hospital away. It is an insult to the people of St George. St George Hospital either matches or can beat St Vincent's Hospital hands down on the basis of a whole range of criteria. This is not a matter of transferring St Vincent's Hospital to St George Hospital; it is eliminating one great teaching hospital and forcing St George to absorb the workload. A teaching hospital is chopped out and St George hospital has to absorb the teaching hospital's work.

I predict, knowing the health system as I do, that during the next few years St George will go into meltdown and the waiting list will go through the roof. St George Hospital will not cope with this change in the short and medium term. Rest assured, the Government will regret what it has done. St George Hospital is in the electorate of the Minister for Transport, and Minister for Tourism and he will regret what has been done today. If the
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Government believes that the people of St George are biased about their leagues club, I can assure it that they are also biased about their hospital. I refer to Bob Carr and how he handles consultation. An article in the Daily Telegraph of 9 march under the headline "New softer image to save Carr" said:

Mr Carr has been advised he needs to take a more consultative approach to reform.

On 25 March 1996 an article in the Sydney Morning Herald under the headline "Carr takes the hint: it's time to hasten slowly" said:

The pace of the Government's reform program would be slower over the next year. "I think it's going to be a friendlier 12 months because we've created so much on the public sector reform front and on fiscal management," he said.

That is a joke. Today the Premier has tried to pull the Minister for Health back from the brink, and will have a consultative committee look at this matter for four weeks - but changes cannot be expected; there will be no changes. That is the method of consultation the Premier applies - he broke his promise on the tolls, ravaged Government House and the Governor's role, and he is now applying the same consultative approach to the ravaging of the health system. The privatising of St George Hospital and the deal negotiated between the health Minister and St Vincent's reads like a Demtel ad: for just one dollar a year you can buy a brand spanking new hospital at St George worth $500 million, funded by the taxpayer. But there is more! The cost of the transfer of the Darlinghurst campus to the new Kogarah campus will also be taxpayer funded. The building costs to accommodate St Vincent's staff will also be taxpayer funded. Apart from the peppercorn $1 per annum rent, the Sisters of Charity will not be required to contribute one cent towards these substantial expenses.

But wait, there is more! The sum of $10.5 billion of public money has been committed to the Sisters of Charity over the next 50 years to operate that hospital - for $1 a year. I wish the Government had asked me or maybe the Anglican Church or one of the other great organisations in this country to run St George Hospital. But no, it was given away with no consultation or discussion. The Government said, "There is your hospital. Take it." I would like to say that there is more. I would like to throw in a set of steak knives, but the knives have already been stuck fair and square in the back of the staff and supporters of St George Hospital.

This is a devastating blow to the people who have been committed to that hospital for more than 100 years. The centenary of the hospital was celebrated in the last couple of years. I would like to know the position of the local members on this issue. Where are Brian Langton, George Thompson and Morris Iemma? I would like to see them tonight at the public meeting at St George Leagues Club defending their Government's decision. At least Brian Langton has said is good for the people of St George. Where is Gabrielle Harrison? We have not seen her stick her head up once. Yet right through the Parramatta by-election campaign she was extremely vocal about Westmead Hospital. But she has said not one word about the cuts to services and beds at Westmead? Peter Nagle, the honourable member for Auburn, is not saying anything about the cuts to his local hospital. Where are the new members whose hospitals are being slashed and burned? They have gone to ground because they know that this whole program is about net cuts to the health system driven by the Treasury, and they will all pay for it. [Time expired.]

Mr MARKHAM (Keira) [2.54]: It gives me great pleasure to debate this no confidence motion. I cannot believe the joke the coalition is making of the whole process. Friday, 21 June was a good news day for the Illawarra; we received the best news we had had for many years. Under the coalition, health care in the Illawarra was totally disregarded - to the extent that Kiama hospital was closed. The coalition started the clinical services block for Wollongong campus by digging a hole, and then walked away from it - after promising in 1988, again in 1991 and again in 1994 that $50 million would be available for the project. The hole was not even completed. Under the Labor Government and under this Minister for Health the project was restarted and it is well and truly on the way. The people of the Illawarra will never forget what the Greiner-Fahey Government did with the Wollongong campus after the clinical services block had been promised for years.

The Illawarra had second-rate hospital facilities and we had to fight, struggle and scream to get recognition that the Illawarra is one of the great regions of this State and deserves the best health care system that can be provided. The Minister is providing that. I assure the House that the people of the Illawarra are applauding the Minister and the Government. The teaching hospital which the people have always craved will become a reality. Wollongong and Port Kembla campus will become a teaching hospital. We have strived for additional health dollars in the Illawarra. We have always been told by the Illawarra Area Health Service that until we have a teaching hospital we cannot tap into the additional funds. The people of the eastern suburbs and the north shore have had the best access to health services. People from the Illawarra wanting to access those services have had to travel for more than an hour.

Why should such services not be provided in the Illawarra, which produces vast wealth for the State? The people there have been treated as second-class citizens for too long. I welcome the provision of the additional linear accelerator, and Dr Phil Clingan is ecstatic about the decision. Having two linear accelerators in the Illawarra will reduce the number of cancer patients who have to travel to Sydney - another plus for the Minister. And people have the hide to say that they do not have confidence in the Minister! I welcome the extension of the orthopaedic section of Shoalhaven hospital.
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It is further south than what is generally referred to as the Illawarra but to me it is part of the Illawarra. This extension is long overdue.

The coalition downgraded Coledale and Bulli hospitals and closed Kiama hospital. The local members - the members for Bulli, Keira, Kiama, Illawarra and Wollongong - struggled to overturn those decisions. Not until the election of the Labor Government did we get sense in health care in the Illawarra. The hard-working people in the Illawarra community appreciate the hospitals they have even though they have not been up to standard. They have been prepared to put their shoulders to the wheel by raising funding through a variety of activities to ensure patients are properly treated.

In February last year Mr David Eldridge, Chairman of the Children's Ward Community Fundraising Committee, wrote to the Deputy Leader of the Opposition, who was then Minister for Health, asking for $250,000 to make up the target of $1 million. The Minister did not respond to the letter. There was a change of government, with the Carr Government elected in March. Mr Eldridge then wrote to me requesting assistance in gaining the $250,000 from the new Government. He asked me to set up a meeting so that the committee could put its case to the Minister. On behalf of members representing electorates in the Illawarra I approached the Minister and put the case to him. The Minister said it was not necessary to meet a delegation because the case that I put forward on my own behalf and on behalf of my colleagues was sound. He assured me that he would examine the matter carefully. Within months, the Minister announced that the Government would provide $1 million for the children's ward appeal.

The appeal has raised more than $2 million. Indeed, it has raised about $2.3 million, including the $1 million, which resulted from the Government matching the amount raised dollar for dollar. That shows how hard people worked to raise the necessary funding. The same support had not been provided by previous governments. The claims by Opposition members that they have no confidence in the Government or the Minister for Health are contradicted by such activity and commitment. Late last year or early this year, the combined rotary clubs of the Illawarra approached me about their project to raise $100,000 to outfit a new renal dialysis facility. Under previous Governments, the old facilities became so cramped that one of those receiving treatment took a turn, there was nowhere to lay that person down. The nurses and staff on the ward were worked off their feet. Indeed, the ward had to operate until 2 a.m. three days a week to ensure that patients received the necessary blood purification treatment.

Dr Perl, who is now deceased, undertook the task of ensuring that the ward, which is in the old nursing home, was transferred to the sixth floor of Hickman House. He identified that $500,000 was necessary to complete the new ward. The combined rotary clubs decided to run the fundraising appeal because a number of their members required the service. They asked me to raise the matter with the Minister. I said that I would be more than happy to do so. I spoke to the Minister at length about the appeal. He agreed to match the $100,000 dollar for dollar, so $200,000 was made available to local hospitals for important monitoring services and dialysis machines. Several other community groups considered the fundraising program worthwhile. The Illawarra Zonta Club and the Illawarra Dialysis Association put their shoulders to the wheel to ensure the funds were raised.

On Monday I had the distinction of opening the haemodialysis ward named in honour of Dr Perl. He was only 45 when he died. Those involved in the fundraising appeal who attended the opening were proud indeed. At the opening I spoke to Dr Perl's wife and two children about his hard work. Dr Perl realised that the only way to secure funding was by working hard, pressuring the Government and calling on the community for support. The Government responded to the pressure. I told Dr Perl's family that it was disappointing that he was not there to see the fruits of his and other people's labour come to fruition. A teaching hospital in the Illawarra will attract more expertise and more specialists, who will be committed to the Illawarra. Specialists have always rejected the Illawarra because it did not have a teaching hospital. They looked to the bigger hospitals in the inner city with teaching status. An article in the Illawarra Mercury on 26 June this year was headlined:

Uni predicts expertise research boost as hospital upgrade flows on

The accompanying article read:

Wollongong university is looking forward to a boost in expertise and research facilities after the announcement that Wollongong hospital will be upgraded to teaching status.

That announcement will have enormous flow-on effects. Patients will have access to better services, and Wollongong University will be enhanced because it will attract skilled people with expertise. Honourable members should thank the Minister for Health for that. The new program is about equity and equality. The health dollars should be spent in the areas with the greatest populations, so that people do not have to travel long distances to access health services.

A second linear accelerator at Wollongong Hospital will help many families. I have had personal contact with Dr Clingan at the Wollongong cancer care centre. A couple of years ago my brother-in-law was diagnosed with a serious cancer. If the linear accelerator had not been available, who knows what would have happened? I applaud the Government and the Minister. I congratulate the Minister on taking the hard decisions to look after the regions, particularly the Illawarra. The Illawarra has earned its improved services and
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facilities. For too long those who live in the Illawarra have been regarded as a second-class citizens. The Illawarra will go from strength to strength, and I congratulate the Government for the decisions it has made.

Ms MOORE (Bligh) [3.09]: Today I give a message to the Premier and the Deputy Premier from the people from the inner city and from the east, some of whom are one-time Labor supporters. They are angry and disillusioned. They do not want millions of dollars of public money handed to Rupert Murdoch for an entertainment complex. They want funds allocated for desperately need infrastructure to deal with the pollution-laden traffic invasion, and they want to keep St Vincents Hospital. The debate is about the Government's secretive processes, economic rationalism and cost-cutting exercises, and the Treasurer's obsession with a balanced budget, which will be paid for in human lives.

In recent days, and in the House today, members of Parliament from both sides of the House have been attacked for defending the needs of their electorates. That is one of the saddest things that I have heard in my eight years as a member of Parliament. I wholeheartedly support the contention that the west, the Illawarra, and the Hunter should have adequate health services. The fact that adequate services were not put into growth areas has been an absolute scandal. People were dumped in there by non-caring governments, and only today is the provision of those services being thought about. Those areas should have adequate health services, but that should not be at the expense of inner-city services. Both areas are entitled to health services, and what is needed is a greater allocation to the health budget.

The Government is supposed to govern for everyone in New South Wales. Instead it is playing honourable member against honourable member, electorate against electorate, and east against west. That is an absolute scandal. The Premier and the Minister stand condemned for what they are doing to this Parliament and to the leadership of this State. The proposal relating to St Vincent's Hospital means that yet another Government promise has been broken. I am not a member of the Opposition member; I do not hope to win government as a result of these attacks. I am an Independent. I assess all the issues that come before the Parliament on their merit. I give credit where credit is due. But those who live in the inner city are totally disillusioned with the Government. Before and after the election the Minister stated categorically that St Vincent's Hospital would remain as a public hospital. I want to refer to some election material that the Labor candidate for the electorate of Bligh distributed during the last election campaign. She claimed that a vote for her would mean wins for the community on three important issues. A campaign leaflet stated:

Labor will ensure that St Vincents remains fully within the public hospital system. We will rebuild public hospitals to make privatisation unnecessary.

. . .

A Carr Labor Government will support and expand our public health system. Labor will stop the privatisation and closure of hospitals. Labor will -

wait for it -

•Increase funding for health.

•Abandon productivity cuts.

•Ensure the full health budget is spent on health.

•Dedicate funds from a new casino to health services.

•Spend revenue on patients, not consultants.

I have heard talk from some members of Parliament that no-one ever expects election commitments to be honoured. That has been the talk in the ethics committee of this Parliament. It is disgraceful! No wonder that the community is disillusioned with politicians and with the major political parties. The Minister endorsed the commitment to maintain St Vincent's Hospital on the Darlinghurst site as recently as November 1995 in the estimates committee. I refer to an answer he gave to me in this House last year in response to my question about honouring the memorandum of understanding to assure the future of St Vincent's Hospital on the Darlinghurst site. The Minister stated:

St Vincent's Hospital is seen as a major world leader, particularly with respect to tertiary services . . . it will ensure that public hospitals are built up and strengthened . . . The Government will put patients first; it will put patients back into the hospitals that the previous Government refused to allow patients into . . . The Government will ensure that St Vincent's Hospital continues to flourish and to provide a service of high quality that many people in New South Wales wish to use and are entitled to use.

That is just like the lie about the Rachel Forster Hospital. The Minister for Health, when he was Opposition spokesman on health, moved a motion of no confidence in the former Minister. As recorded in Hansard of 11 October 1994, the Minister said:

That is another broken promise, just like the disappearing nurses, the evaporating hospital beds and the vanishing hospitals. This Minister breaks promises like Kieren Perkins breaks records. This is just another example of the Minister's desperation and dishonesty.

I cannot think of any better summary of the Minister's behaviour. The decision to downgrade of inner-city health services was made in secrecy. It was only through the media last Friday morning - I received my first phone call from the Daily Telegraph at 6 a.m. - that I learned about what was to happen to St Vincent's. St Vincent's Hospital serves the poor and underprivileged in the city, the drug and alcohol addicted, people living with HIV and AIDS, the aged, Department of Housing tenants and single mothers caught up in the poverty cycle living in my electorate. Today in question time the Minister was seen laughing and trivialising that important issue.

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I understand that the deal hatched between the Minister and others took 2½ weeks. Everyone involved in that deal was sworn to secrecy. Although I have fought for many years for the Sisters of Charity to ensure that the St Vincent's Hospital remains on the Darlinghurst site, they were unable to inform me of the impending loss to our community of these health services. Ironically, the Minister had offered to make a senior officer regularly available to me to update me as needed about health matters in my electorate. At our last meeting, he failed to mention the destruction of St Vincent's Hospital. That must have been an oversight on his part. The announcement was made at the end of a parliamentary session. I was hurried into the Minister's office, given a five-minute interview, told that it was a fait accompli, and that it was all about equity. The Minister then made his announcement.

It occurred to me on Sunday night that the Premier and the Minister for Health did not need to watch the television program about Machiavelli because they are working examples of what Machiavelli espoused and stood for. The aim of the realignment in the southern and eastern health services is to downgrade St Vincent's; it is to save the Government $50 million. The proposed amalgamation is part of a calculated effort to eventually reduce the public hospital services of the inner city. The amalgamation will result in a contraction of services for the south-eastern area. Staff at St Vincent's Hospital and St George Hospital will suffer as a result. I was told yesterday by a practitioner that the intensive care units at both hospitals are currently working to capacity.

The theatres at St George Hospital are operating at 90 per cent capacity. How will that hospital cope with the load from St Vincent's? It will have only a 10 per cent extra capacity. How will it cope with the additional operating need? The nursing staff have been assured of job security. However, the non-nursing staff have received no guarantees at all. The actions of the Government call its priorities into question. The Government is proposing the destruction of a world-class hospital. In the same area and at the same time the Government has approved the development of the Fox studio and entertainment complex on the Sydney showground site. Over the next five years $105 million of public money will be allocated to the Murdoch group, which made only $1.5 billion last year.

The inner city will lose St Vincent's Hospital, and Murdoch will get $105 million over five years. What are the priorities of this Labor Government? Other honourable members have spoken about St Vincent's Hospital, but I want to point out that it is one of Australia's premier teaching and research hospitals. Its reputation has been built up over 139 years. It is a regional health facility and a centre of excellence for all people of New South Wales. It provides treatment for HIV and AIDS, treatment for cancer, bone marrow transplants, treatment for heart-lung and other cardiac-related conditions. It also serves some of Australia's most disadvantaged.

More mentally ill people reside in my electorate than in any other electorate in the State. The Bligh electorate has the largest concentration of the homeless, the drug and alcohol addicted, a disproportionate number of women with breast cancer, an increasingly large number of ageing people, and a large number of Department of Housing tenants. St Vincent's also treats the one million people who work and visit Sydney each day, as well as the thousands of people who are part of the booming tourist industry and visit the city at night. Because of the hospital's close proximity to Kings Cross and Darlinghurst, St Vincent's has probably the busiest and most active casualty centre in the State. A small community hospital will not be able to cope with those needs. Indeed, even to suggest it is laughable.

I want to refer specifically to the HIV and AIDS services offered by St Vincent's. Those services will suffer as a result of the proposed amalgamation, regardless of what the Minister says. Indeed, that is the fear of the AIDS Council of New South Wales. Proper treatment of HIV and AIDS requires the support of comprehensive hospital services. The major systemic changes announced by the Minister require in-depth consideration. The changes should not be plotted and a decision arrived at in 2½ weeks. St Vincent's provides expert clinical services, particularly those related to complex health problems that affect people with HIV and AIDS. Those problems range from dementia to cancer to fungal infections to lung infections. During the election campaign the Government also promised not to reduce funding for HIV and AIDS services.

A recent American study found that AIDS in-patients admitted to less experienced institutions were 2.92 times more likely to die within 30 days of admission than those who chose hospitals expert in the treatment of AIDS. Diagnosis is increasingly the province of many people, including nurses and laboratory staff, rather than a single doctor. They need extensive AIDS experience if they are to play a critical role in diagnosis. That experience has also proven effective in diagnosing other infectious diseases. St Vincent's has the advantage of being a major public hospital with whole departments specialising in different disciplines and with specialists on call. An AIDS unit does not exist in isolation, as the Minister proposes. Without the services I have referred to and the backup of expert medical teams, the staff will not be able to provide the requisite level of expert knowledge and care. The hospice and the Garvan Institute will suffer similar adverse impacts. I want to refer briefly to a speech given by Professor David Cooper when the AIDS ward, Cahill 17, was opened at St Vincent's Hospital in 1995. He said:

. . . today we are gathered to celebrate the opening of our magnificent, purpose-built HIV ward . . .

Page 3802

This unit is internationally recognised. When HIV clinicians and researchers around the world think of HIV in Australia, they think first of St Vincent's. The international reputation of Australia in HIV medicine is founded on the clinical research, drug trials and care that has been provided over the years at St Vincent's. This research, I might add, generates an additional several million dollars in revenue every year, which returns to benefit the St Vincent's campus and, ultimately, patient care . . .

So we are here today to celebrate the finest HIV Unit in Australia in arguably one of the finest hospitals in Australia -

that is the hospital that is to close -

We can provide the most cost-effective care in a dedicated facility where costs are kept down through patient volume and clinical experience. Every Government dollar spent here at St Vincent's on HIV returns exponentially more than a dollar's worth of care, because we are a centre of excellence.

That is what the community will lose. Whatever the Minister says, I want to ensure that the Parliament understands that. I also have concerns about the combined campus proposal. Prince Henry and Prince of Wales hospitals could not cope with only Anzac Parade between them. Therefore, Prince Henry Hospital is to be amalgamated with Prince of Wales Hospital. I wonder how St Vincent's and St George hospitals will operate cooperatively as a combined campus. With current traffic gridlock it can take an hour to travel two kilometres in my electorate in the vicinity of St Vincent's.

Mr O'Farrell: You do not have the Eastern Distributor.

Ms MOORE: No, my electorate does not have the Eastern Distributor. Indeed, the Sydney Swans recently complained that people are missing part of the Swans' matches. If an ambulance is unable to reach either Kogarah or Darlinghurst, watching a football match is not the only thing that will be lost; a life will be lost. This debate is not about a combined campus; it is about the destruction of what is arguably Australia's finest hospital. One of the Government's policies is to increase the population in the inner city. In the next decade another 30,000 to 40,000 people will come to the inner city as part of the Government's urban renewal project. I want to refer to a letter that appeared in yesterday's Sydney Morning Herald, which said:

At great cost, St Vincent's has, over the past several years, acquired a new clinical services building containing state-of-the-art operating suites and support services, refurbishment of existing wards, expanded radiotherapy facilities and many smaller yet important additions and refurbishments.

Now, at the stroke of a bureaucratic pen, it seems many of these facilities are to become redundant, under-used or completely abandoned.

Instead of productivity savings, the result has been waste. There is a hidden agenda behind the change in the philosophy of the former Opposition spokesman on health, who constantly condemned the previous Minister for privatising hospitals. This proposal is privatisation by stealth. Public patients will be contracted to the private hospital, and that has frightening long-term implications. I will conclude my sad comments on a lighter note. I must respond to the Labor Deputy Mayor of Liverpool who, at a media conference yesterday sponsored by one of the Premier's staffers, accused me and my constituents of being a cappuccino crowd, trendies and spivs. The Australian Labor Party has a bit of a thing about my electorate. Government members talk in this House about the needs of the west and the Illawarra, but where do they end up? I would like to tell honourable members about some of my constituents. They include Gough Whitlam, Neville Wran, Paul Keating is just about to move in, and the Treasurer, Mike Egan, has a nice little apartment in Surry Hills. Bob Hawke was there for a while with Blanche.

Mr O'Farrell: And the member for Broken Hill.

Ms MOORE: And the member for Broken Hill. The Labor Party might condemn the electorate of Bligh, but that is where they like to end up. The ALP also has a preoccupation with the cafes and cappuccinos in Bligh. People come from all over Sydney to have a cappuccino at the cafes in my electorate. But the two who are particularly taken with Stanley Street, cappuccinos and cafes in Bligh are the Premier and the Treasurer. When the Premier was Leader of the Opposition he was seen every day at Bill and Toni's, and the Treasurer can be seen there most weekends. It is a common stamping ground, and why not? It is a delightful place and makes an important contribution to city life. I have described to the House the serious needs of the disadvantaged, who are living in the city at a time of social dislocation and increasing poverty. They are the people the Labor Government should care about, as it should care about maintaining a world-class hospital on its present site and honouring commitments made again and again. But that Minister cannot honour commitments. I do not think he knows how.

Mr CRITTENDEN (Wyong) [3.24]: I want to speak briefly about the benefits of this decision for the people of the central coast and Wyong. In so doing I reject totally the no-confidence motion moved today by the Leader of the Opposition. The people of the central coast have been discriminated against in relation to the delivery of health services. However, I am pleased to say that this decision will bring that discrimination to an end. For years the population of the central coast has been growing rapidly. The honourable member for Bligh referred to that. However, the level of health spending in my electorate has failed to keep pace with that growth. Last year an average of only $536 was spent on health services for individuals on the central coast, compared to an average of $1,152 for people in central Sydney.

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One does not have to be a mathematical genius - indeed, one only has to be a reasonably competent fourth grader - to realise that the amount of money spent per capita on health services for central coast residents is less than one-half of the figure for Sydney residents. That has led to an increasing number of my constituents being forced to travel to Sydney to access the health care they need. Under the current funding arrangements, which the Labor Party inherited following seven years of coalition mismanagement, almost 95 per cent of all central coast patients needing tertiary health services are forced to seek treatment away from the central coast area. They have to go either to the John Hunter Hospital or to Sydney. Even for basic health services almost 16,000 people had to travel to the inner city of Sydney for treatment. That is what the Liberal Party thinks is a fair go for the central coast.

I am tired of visiting my constituents and friends from the central coast at hospitals in Sydney - at the Royal Prince Alfred Hospital, Royal North Shore Hospital, Prince of Wales Hospital, and the list goes on. Worse than that, their immediate families have to come to Sydney and often make very costly arrangements to stay while their loved one is receiving treatment. In short, this proposal is about fairness, equity, righting wrongs, making sure that the inequity does not persist and helping the people who live in the growth areas of the State. I am pleased and proud to say that I represent the Wyong council area, one of the fastest growing local government areas in New South Wales. For the first time the services needed by the people of the central coast will be provided on the central coast. Because of this courageous decision there will be an additional 34 beds in the Central Coast Area Health Service. Day surgery will also be expanded.

The Government will fund the obstetric service facility at Wyong and ensure that it will be open in the near future. In addition there will be provided a new medical ward for Gosford District Hospital, in the electorate of my colleague the honourable member for Peats, a very hard-working member who has fought vigorously for improved health services in the peninsula area - unlike the honourable member for Gosford, who cannot be bothered to speak in this debate or even remain in the Chamber to stand up for the people of the central coast. It is a sad indictment that today this House is debating a no confidence motion on a Minister who has had the guts to stand up and be counted. For the first time in eight years we have a Minister who will bring equity into this sorry state of affairs. By a coincidence, the Central Coast Area Health Service will get a further 34 beds and the Royal North Shore Hospital will lose 30 beds. The North Shore Times of 26 June states, on page 1:

Thirty beds slashed. Fund cuts to hit RNS

There is no doubt that Royal North Shore Hospital is an excellent institution and provides excellent health care. But the fact is that most of the population does not live in close proximity to the Royal North Shore Hospital or the other hospitals mentioned. There has been a demographic shift in New South Wales. People like to follow the great Australian dream of the quarter-acre block with a brick veneer house on it and a backyard for their children to play in. I believe that is what has brought fundamental stability to this Australian nation. Quite rightly, a lot of people move to the central coast because that is the dream they are chasing. It is important that we provide services for those people. It is important that we provide equity. It is important that we provide basic health services, basic education services, roads and other services the State Government is obliged to provide in a fair and reasonable manner. This no- confidence motion is nothing more than a sleight of hand, a shocking indictment of an Opposition with a paucity of policy, a paucity of leadership, and a paucity of talent that simply cannot adjust to changed circumstances.

The Central Coast Area Health Service will receive $4 million in additional recurrent funding to expand the aforementioned services and provide the same level of service as residents receive in the inner city of Sydney. Most importantly, for the first time the rapid growth in population on the central coast will be matched by an equally rapid increase in funding for health services. Another reason this decision is such good news for the people of the central coast is that the new resource distribution formula takes into account the seasonal population factors due to the burgeoning tourist industry on the central coast. This is particularly important because, through no fault of the chief executive officer, Dr Stephen Christley, or indeed the health board, which was solely appointed by the previous administration, this current financial year the Central Coast Area Health Service will have a $1 million cost overrun. In large measure that is because many people go to the central coast for their family holiday. They come and hire a flat, unit or caravan; the children get sick, they cut their feet. That has led to a massive increase in the health provision required of the Central Coast Area Health Service, which does an excellent and compassionate job.

Not only will the central coast receive increasing dollars to match its increasing population, it will also get extra money to cater for the great influx of tourists. This is a great decision not only for the central coast but for New South Wales, because the benefits under the resource distribution formula do not stop this year. That is what is really worrying the Liberal Party. It is really worried because the central coast and other growth areas will receive a fair slice of the cake not only in the coming financial year but in succeeding years. I turn now to some of the comments that have characterised this debate. The Leader of the Opposition launched a no-confidence motion on the Deputy Premier and Minister for Health, yet most of his 20-minute contribution was taken up with
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self-justification. He tried to justify his existence as a health Minister of this State. Well he might. When he was health Minister he presided over a massive change in the health system, all bad for Labor Party and National Party areas.

During the seven years of the Greiner and Fahey governments 30 hospitals were either closed, downgraded or privatised. Quandialla Hospital and Binnaway Hospital - National Party hospitals - were closed. Of course, he got away with it. The time has come for the hard decisions. The time has come to stand up and be counted. I am pleased that the Minister has taken this hard decision. It was not an easy one; people do not like conflict. But sometimes leadership has to be shown - and only the Labor Party can show that leadership. It became more laughable when the Deputy Leader of the Opposition, the member for Miranda, talked about a few scraps being thrown at the central coast. An additional $4 million is not a few scraps. In fact, we could not get a scrap out of the Deputy Leader of the Opposition when he was the health Minister. He was that lovely fellow who built the obstetrics facility at Wyong Hospital. We had all the buildings, all the facilities, we even had vacant beds. But he would not provide the recurrent funds to ensure the hospital was utilised for the purpose it was built.

We had a classic "Yes Minister" situation. The hospital was built but was not provided with the funds to ensure the hospital could be used. We had a vacant building. This situation went on and on, and what a sorry tale it was. Of the $4 million allocated to the central coast, $900,000 is recurrent funding for the obstetrics facility at Wyong Hospital. The hospital will have a 24-hour a day, seven-day a week operating theatre capacity. The theatres will function for 168 hours a week. When this Government came to office, the operating theatres functioned for an eight-hour shift on five days each week, a total of 40 hours per week. However, last year the Minister for Health increased that to three nights a week, to a total of 50 to 52 hours of operating time per week. Theatre operating time will increase more than threefold to 168 hours a week. There will be growth on the central coast and vacancies for doctors and nurses.

I welcome applications from health professionals for appointment to Wyong Hospital. The Government's proposal will mean real jobs for real people. The people in my electorate live, breathe, sleep and eat; they even get sick. When they get sick they deserve the best treatment, the same treatment that residents of central Sydney receive. During question time the shadow minister for health, the honourable member for North Shore, asked where people will get jobs. She commented that people would not want to go to Lismore, for example. I regard that as a grave insult to the honourable member for Lismore, and to the people of Lismore. I live in a very pleasant area with very pleasant people and I do not believe that others will be as negative as the honourable member for North Shore has suggested; I believe they will come to the central coast.

Even more worrying is the fact that the honourable member for North Shore is anti-women. She believes that the women in my electorate do not deserve obstetric facilities; she believes they should continue to travel for 45 minutes to either Gosford Hospital or Belmont Hospital to have their babies delivered. Last year a woman gave birth at the Caltex service station on the F3 freeway. Earlier this year a woman who required a caesarean section presented at Wyong Hospital on a night when the operating theatres were not functioning. She demanded that the caesarean section be performed. I am here to demand a fair go on behalf of my constituents - nothing more; nothing less. They have been waiting a long time for facilities. The building is there and we now need to ensure that it is utilised for the purposes for which it was constructed.

Dr MACDONALD (Manly) [3.39]: I support this motion of no confidence. Had the Leader of the Opposition not moved it, I would have. I am saddened that this day has arrived. In this debate and during question time honourable members have listened while one community has been pitched against another, and the Minister for Health is responsible for that. I have no confidence in the Minister, who plans to dismantle health services in the Manly area. A Government that makes decisions such as this deserves to lose the election in 1999. The support - mine and that of the Manly community - that the Minister for Health may have enjoyed has plummeted as a result of the Government's decision. The redistribution argument put forward by the Minister is a hoax. The changes do not constitute a redistribution, they constitute a reduction in health services. How could the loss of 1,800 jobs, including those of 900 nurses, not mean a reduction in services? The proposed downgrading of Manly hospital has struck a chord with me, because the hospital is close to my heart.

I was appointed to the staff of Manly hospital as an anaesthetist in the 1970s, I know the hospital very well and I know the role that it plays within the community. Anything that hurts Manly hospital hurts me. The lack of information in the debate was characterised by the honourable member for Wyong, who talked about how the central coast gets only half the number of dollars per head that some metropolitan health areas receive. Of course that is the case, but we have tertiary hospitals in the city. I do not think it is a bad thing to move tertiary beds into country regions - indeed, that would start to level out relative funding - but to penalise district hospitals, as the proposal to downgrade Manly hospital will do, is unforgivable.

The process that led to the announcement of the downgrading has been a sham, characterised by deceit on the part of the Minister for Health. It all
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began in November 1995, in secrecy. Countless meetings, which have been constantly denied, took place between staff and area health services. I was pilloried in the press by people such as the Minister and his underlings in the area health service who said that nothing was going on, that I was only beating it up. Documents were constantly leaked to my office indicating that we were about to get the sort of bad news that we got last week. That was also constantly denied by the Minister. Longstanding and long-serving executive hospital staff were moved out of the area. The asset strategic plan, which was meant to be the blueprint for future planning, stated:

The principal objective of the Asset Strategic Planning Project being undertaken in the NSAHS is to produce a plan which will ensure that the major assets of the public hospitals in the area will be able to cater for the projected health needs of the community efficiently, effectively, and with anticipated resources, into the 21st century.

We were told that this was the plan we were to rely on; and that we would have maximum input into the plan. This is the very plan that has been subverted by the Minister. The announcement last week caused total confusion. Documents were issued by the Department of Health suggesting that the maternity unit was to be moved to Mona Vale, and press releases were issued by the Minister's department contradicting that and saying the proposal would be subject to community consultation. That was a sign to me that when one starts to usurp the process of proper planning, one receives confused messages. The effect of the proposals on Manly hospital will be devastating. It is the only public hospital in the peninsula area that has a properly staffed intensive care unit, acute stroke unit, oncology unit, cardiac rehabilitation unit, on-site CT scanning and cardiac ultrasound. This Minister will be responsible for dismantling that hospital. Manly hospital is the only local hospital that has a maternity unit with a high risk clinic.

Why would the Government want to sacrifice all that? The proposed changes will affect young mothers who want to have their babies at Manly; the elderly will not have access to orthopaedic facilities; and women's health will be affected because there will be no gynaecological facilities. Anyone with an understanding of the way that hospitals work would appreciate that the loss of orthopaedic facilities, vascular surgery facilities and gynaecology services will have a very serious impact on the anaesthetists' rosters and the hospital will begin to self-destruct from that point onwards. These changes have occurred without any consultation. The intensive care unit has had an absolute slap in the face. Members of that unit were invited by the executive director to enter into negotiations with the adjoining Mona Vale Hospital, to consider ways in which services could be rationalised. They accepted the invitation and produced a document which acknowledged that a way could be found for the two hospitals to work together. At the end of the day the process was proved to be a sham and was thrown out by the executive director. Honourable members are now witnessing what will be the effective dismantling of intensive care at Manly hospital.

The maternity unit at Manly hospital is probably the best for its size in Sydney, using valid indicators such as ability to handle critical care and the fact that it is a teaching unit. In respect of full-time staffing equivalents, it is better than any hospital in the region. Almost 1,000 babies are born there each year and that number is increasing. Staff morale has been devastated. On one afternoon recently 300 people abseiled off Sydney Harbour Bridge and raised $30,000 for that hospital. The hospital also conducts an annual bed race, which I take part in every year. Dozens of people pay $250 per bed and the hospital raises approximately $30,000 each year. What will happen this year? Who would bother to push a bed up Darley Road after this sort of news from this Minister? Harbord Diggers Club, the biggest club in my electorate, has donated $976,000 to Manly hospital since 1986. Who would want to donate money now, when the Minister is about to dismantle the hospital at the stroke of a pen?

The Minister is an absolute disgrace. This year is Manly hospital's centenary year, but it has nothing to celebrate. A brochure that has been circulated by Manly hospital, which makes reference to a calendar of events, states that the hospital is working with the Harbord Diggers Club to promote good health. The brochure also states that people should get to the hospital quickly if they have a heart attack, but that will not be much use as the hospital no longer has a critical care unit. The brochure contains good news messages from the executive director at Manly hospital, but the Government is dismantling that hospital. It is sad that the Government is making a number of plans behind closed doors. The Medical Staff Council of that hospital in a memorandum dated 28 November said:

Given assumptions are that there will be $5-10 million less money . . . and 50-65 less acute beds available to the peninsular in 5 years time. Cutting clinical services will only result in more severe budget cuts because a sort of case-mix funding will be introduced in 1997-98.

The memorandum continues:

The working hypothesis is that there will be a single "Northern Beaches Hospital" with differentiation of services between the two hospitals. The sort of cuts we need to make will require that only one site has intensive care, full casualty services, maternity etc.

That prediction was made by the Medical Staff Council in November - a prediction denied by the Minister and by senior people in the Northern Sydney Area Health Service. The Northern Sydney Area Health Service, in its asset strategic plan, predicted a 42 per cent increase in acute hospital admissions in the period between 1994 and 2006. Those projections were undertaken by independent planning consultants - the Health Services Research Group. This prediction of increasing demand is
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consistent with population statistics. The asset strategic plan, which was provided by Rosemary Harrison, executive director, nursing, at a combined meeting of nursing staff from Manly and Mona Vale hospitals on 2 February 1996, contains statistics reflecting current population and projected population in the year 2001.

The area covered by the Northern Sydney Area Health Service has been split into four zones. In the northern area the population, currently 245,600, is projected to be 246,500 in 2001, which represents very little change. In the lower north shore area the population, currently 162,000, is projected to be 136,900 in 2001, which represents a drop in the population in that area. In the Ryde area the population, currently 107,900, is projected to be 91,300 in 2001. In the northern beaches area - the area about which I am talking - the population is 217,400 and it is projected to be 285,900 in 2001. There will be a 35 per cent population increase in the northern beaches area, but the Government is ripping the guts out of one of only two hospitals in that area. We will be left with one small hospital at Mona Vale which has fewer than 200 beds - the Government does not plan to expand that hospital - for a population of almost 300,000. The Minister will be held responsible for that. Lives will be lost.

Mona Vale hospital, a tiny hospital, cannot cope. It does not have the facilities or the capacity and it does not have enough theatres. People in that area do not want to travel to Nepean or Wyong for treatment. The Manly-Warringah peninsula is an island with poor access and poor public transport. It takes at least 40 minutes to travel 27 kilometres from Mona Vale to St Leonards between 12 p.m. and 2 p.m; it takes 30 minutes to travel 16 kilometres from Manly to Mona Vale in non-peak periods; and it takes more than 35 minutes to travel 14 kilometres from Manly to St Leonards in non-peak periods. Lives will be lost. Manly, which is isolated, will not have an effective unit. The fundamental flaw in the Government's policy is that district hospital bed closures will not result in an increase in beds in the west. Only tertiary beds are mobile. The Government's policy will result in fewer services being provided in my area. The Minister misled the House. I believe that he lied to the House on 5 June in debate on an urgency motion moved by me concerning Manly hospital. The Minister said, amongst other things:

I did not criticise the [former Government's asset strategic planning process] because I thought that planning was a good idea.

This major planning exercise which commenced in November last year will continue.

The project commenced in my area. The Minister continued:

It is an important project which must be undertaken by every area and it now comes under Treasury guidelines as a prerequisite for the allocation of funding.

The Minister also said:

Within the asset strategic planning process, options for the future role of each of the hospitals need to be developed. I support the process . . .

The Minister subverted and usurped that process last Friday by announcing, ahead of the finalisation of the asset strategic plan, that the Government would be closing maternity, gynaecology, vascular, paediatric and orthopaedic services in Manly hospital and would be moving them to Mona Vale hospital, which cannot cope. Manly-Warringah peninsula - an area with a high-density population which attracts six million tourists a year - will effectively be left without a hospital. The Minister has a lot to answer for. The former Minister for Health made some fairly radical changes, including privatisation, but at least he was up-front and honest about those changes. The present Minister for Health has been deceitful. No-one highlighted the quasi-privatisation of St Vincent's Hospital. The matter raised by the honourable member for Bligh concerning the contracting of public patients to St Vincent's Hospital has not been highlighted. It appears to me that this fundamental shift in policy, which occurred without any consultation, is akin to what happened under the former Government.

The community will object to this. My community will revolt. Manly Hospital Action Committee, which I chair, was established in May 1993 in the period of the former Government, following a public meeting in my area. At that time the former Government talked about amalgamation and about cutbacks. As a result we established a community committee which has met every month since then. The former Liberal Government abandoned the asset strategic plan because it realised it was unwise, but within months of the Government coming into office that plan was reintroduced in an attempt to rip dollars out of our area. I thank the members of that committee, including Inge Southcott, Marjorie James, Marjorie Hart, Don Morrison and Tony Whitten from the various auxiliary groups associated with the hospital. I also thank the Combined Pensioners Association of New South Wales, which is mortified by the decisions taken by the Government.

I thank staff at Manly hospital. This Saturday we are holding a major rally in Manly. Another rally will be held in a few weeks time. I call on the New South Wales Nurses Association to stand by the hospitals. The association should not make any concessions to the Government and has to be strong in this area. I do not want John Ducker, former Chairman of Mona Vale hospital, heading a review committee, as he will do everything in his power to damage Manly hospital. That is what he did when he was chairman of the combined Manly and Mona Vale hospitals. I condemn the Government. I am happy to support the no-confidence motion. I wish we had the numbers to ensure that this no-confidence motion against the Minister is carried.

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Mr SULLIVAN (Wollongong) [3.54]: Having listened to the contribution of the honourable member for Manly, honourable members would be aware of his selfishness, self-centredness and self-serving qualities. He made no reference to the Minister's fairness and equity in the provision of health services. For too long New South Wales has been placated with empty promises. At long last we have a Minister who is prepared to deliver. I make no apology for the fact that the decision taken by the Government will increase health services for the people of the Illawarra. For years the Illawarra has been neglected by successive governments, but primarily by the Government that was in office from 1988 to 1995. Services and facilities were run down and the needs of the people were left unmet, especially in the development of tertiary services.

For years the people of the Illawarra have been forced to travel to Sydney to access health facilities. I have been reliably informed that on many occasions up to one-third of the patients at Prince Henry Hospital, for example, have come from the Illawarra and the south coast. Patients from the Illawarra have gone to Royal Prince Alfred Hospital and Prince of Wales Hospital. One of my daughters received treatment at the Prince of Wales children's hospital - treatment that she should rightfully have received in Wollongong. Every year thousands have been forced to travel to the inner city for elective surgery, for emergency treatment and for almost all their health needs. I bring to the attention of honourable members a case that was brought to my attention only yesterday. A retired gentleman who lives in a caravan park on the edge of Lake Illawarra and who requires hip replacement surgery came to see me at the end of May. I made contact with him and his doctor yesterday. The gentleman is on a waiting list, and no date has been scheduled for his hip replacement procedure in the Illawarra. The local surgeon says that he needs more operating time so he can treat more patients and therefore reduce his waiting list.

The patient I have referred to does not have private health insurance, and suffering is the only thing he can look forward to in the foreseeable future because no specific date can be set for his operation. However, if he were to come to Sydney he would receive treatment reasonably quickly, because resources that should be in the Illawarra are in fact in the inner city areas of Sydney. The gentleman's wife suffers from ill health, and this poses considerable problems in terms of her ability to visit him and organising for someone to look after her when he is in hospital. The Government's decision on health services brings to an end decades of neglect. I welcome the establishment of the new teaching hospital, the Illawarra Regional Hospital, at the Wollongong and Port Kembla campuses. It is a major achievement that will dramatically lift the standard and quality of health services in the Illawarra. I am pleased that the planning process to implement teaching status will be completed within three months and that the new hospital will be established within the next 12 months.

I welcome also the provision of a second linear accelerator. The first linear accelerator was funded by the local community, which raised almost $1.7 million in less than 11 months thus forcing the previous Government to construct a cancer care centre. At the moment one linear accelerator, which is designed to handle a maximum 450 cases a year, is handling more than 600 cases each year. The second linear accelerator will be well utilised even not allowing for further growth in the demand for the services of linear accelerators. Orthopaedic services have been expanded and improved considerably at Shoalhaven Hospital, which services the many retired people who live in the district. The additional $7 million in funding will expand and enhance existing services in the Illawarra. It will provide additional staff and resources, and that will enable procedures such as the hip replacement operation I referred to earlier to be performed. This no-confidence motion was moved by a former Minister for Health and supported by another former Minister for Health in a coalition Government that was in office from 1988 to 1995. Those two former Ministers were the same people who said to the people of the Illawarra, "You are second class. You are second rate. You don't deserve to be treated any better."

Mr Harrison: They were ashamed to show their faces.

Mr SULLIVAN: That is very true; they were ashamed to show their faces in the Illawarra. This decision - which has been made by a forthright and farsighted Minister - will ensure that for the first time the Illawarra will get its fair share of health services. For the first time we will have the same level of health care as is enjoyed by the people of central Sydney. That is a damning condemnation of the previous Government. The people of the Illawarra have deserved a better deal for a long time but they have not received a better deal. I shall relate some of the history of the provision of health services in the Illawarra to illustrate exactly what has been happening in the region. The clinical services building, which has had various titles over the years, is a classic example. Proposals for such a building were first put forward in 1983. For a period of around four years, with the help of the planning workshops organisation, the local area health service and the Department of Health worked on a plan to address finally the needs of the Illawarra. As a result, a major building and a hospital with teaching status was proposed, and contracts were apparently entered into in 1987.

In 1988, with the State election in March, this clear commitment was made by the previous Government: "We will not delay the construction of that building in Wollongong. We will not delay the establishment of Wollongong as a teaching hospital." The previous Government had a pathetic track record. Up until 1991 that Government did a bit of planning, a bit of hole-digging, a bit of this and a bit of that - for example, shoring-up existing
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buildings and removing some old structures - but basically it was just keeping things quiet. Nothing much was actually happening. The decision to separate the cancer care centre was proceeded with, and the clinical services building was left in limbo. In 1991 the charade came to an end; the clinical services building was given a new completion date of 1993, rather than the original completion date of 1991. Then in late 1991 all work on this building stopped. There has been a huge hole - and even that was incomplete - on the site for the entire period.

The proposal now is to build a major clinical building with five levels and over 15,000 square metres of floor space, representing a major upgrade and expansion of services in the Illawarra - thanks to this Government. It will be built with funds that under a coalition government would have been allocated to inner city areas, which have been pampered for decades. The Minister for Health is distributing funds fairly and equitably, and the only objection has been from those who cannot accept the fact that they will not have better services than everyone else. The cessation of pampering is really what they are objecting to. A second linear accelerator has been provided, building work has commenced, and the planning work to improve the hospital to teaching status - again a major advance in our area - is under way and will be completed and implemented within 12 months.

Coledale hospital activity level has been run down, and although under the previous Labor Government $1 million was spent on it, it was left in limbo between 1988 and 1995. During all that time there was talk of closure of the hospital or sale of the property. There were discussions with nursing home operators, but basically there was no commitment from the previous Government to do anything to ensure that that resource was fully utilised to address the health needs of the community. Bulli hospital is probably the most glaring example of the partisanship of the previous Government. Up until 1988 planning had commenced on a major upgrade of that hospital. At the time of the 1988 State election a quarter of a million dollars had been spent on that hospital, and total expenditure of $4.25 million was proposed. Between 1988 and 1995 funds were withdrawn but nothing was done. When the previous Government was elected in 1988 it said that Kiama hospital would not close and services would not be run down. As soon as the Government was elected -

Mr Harrison: How could we believe it?

Mr SULLIVAN: True, how could we believe it? When the coalition won government the hospital was closed and mothballed. Shoalhaven hospital has one of the most dilapidated ward buildings of any hospital in the State. It has been condemned by the Board of Fire Commissioners, and yet it was utilised from 1988 to 1995. This Government and this Minister have provided funds to have that building replaced, and this will allow for the expansion of services. With regard to financial resources, in the 1980s the Illawarra was slowly starting to catch up with other regions. Interestingly, according to 1996 statistics only two other regions of this State receive lower per capita funding than the Illawarra, namely, south-western Sydney, which receives $471 per capita, and the mid north coast which receives $503 per capita. The Illawarra receives $506 per capita.

By comparison, central Sydney receives $1,152, which is more than double the funding for the Illawarra. South eastern Sydney receives $955. The lie is well and truly nailed to the wall by those figures. In 1988 a formula was introduced as a mechanism to achieve productivity savings and to justify cutbacks in funding. The measure decimated many services and put them under enormous strain for seven long, bitter years of the previous Government. Since 1995 there has been an increase in funding; the Illawarra has received an additional $7 million. The issue is really about pulling into line those in the community who are selfish and self-serving. The Minister has put forward a proposal - which we support - based on fairness and equity for all regions. I ask the following questions. Why should people from the Illawarra, the Hunter, western and south-western Sydney, the central coast and so on have to travel to Sydney to receive their health treatment? Why should the organisation and functioning of families be dislocated because a member of the family must be in Sydney for health treatment?

Why should the Illawarra, western Sydney or the Hunter be deprived of the diversified economic base that such health facilities bring to an area? Many regional centres have narrow economic bases, often consisting of heavy industry. It is crucial that those economic bases are widened. That could be done by the establishment of a university, or by the expansion or diversification of health services. That benefits, in a measurable way, the economic wellbeing of the community. Those are three reasons that I put forward in support of the Minister's proposal. It should be supported, and rightfully so, against the no-confidence motion moved by the Leader of the Opposition. It is appropriate that equity and fairness prevail. No matter where people live, if a proposal can be justified on an economic basis, resources should be allocated where they are needed. If that is not done, families and communities will continue to suffer the dislocation that they have had to put up with for many years. [Time expired.]

Ms FICARRA (Georges River) [4.09]: The Minister is deserving of this motion of no confidence for his insensitive, arrogant, high-handed and secretive deals with our State public health assets, especially the valued human resources - the nurses, the doctors and the administrative staff of the New South Wales hospital system. This is no health services restructure. This is purely a $80 million cut in health services. Minister, you have sold out St George, its residents and the inner city -
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Concord, Manly, Parramatta, Westmead. These cutbacks to the New South Wales health system would effectively see the takeover of management of the St George Hospital by the current management of St Vincent's Hospital.

The St George and dragon crest that has proudly adorned our accident and emergency department has already been removed. Minister, your arrogance knows no bounds. These changes were announced after secret negotiation, without any consultation with the medical staff, the nursing staff and administrators of St George Hospital, and with no reference at all to the people of St George. The most controversial proposal is the renaming of St George Hospital as St Vincent's Hospital. Minister, you have ripped out our souls. The St George region may be expendable to the Carr Government but our heritage - our 101 years of services of excellence and our community identity, our soul - has been wiped out by a stroke of the Minister's pen. We will fight this. Stop-work meetings and rallies are just the beginning. Petitions are being signed throughout the community.

The honourable member for Kogarah holds his seat by a margin of 1.5 per cent. I say to him, "Bye bye, Brian." As for Rockdale and Hurstville, it is fortunate that the members representing those electorates have 9 per cent and 10 per cent margins. But I can assure them that those margins will be whittled away at the next election. We have expendable members in the St George area - all ALP - and we have an expendable Minister and an expendable Government. But the St George area is not expendable. In the days since the Minister's announcement I have discussed this matter with hundreds of people from the St George area, as well as the constituents of Hurstville, Rockdale and Kogarah. They are not satisfied with the responses that they are getting from their local members.

St George Hospital doctors, nurses, administrators and patients, office bearers in licensed clubs that have contributed to the hospital facilities, hospital charities and members of the community are unanimous in their attitude: absolute opposition to the proposed changes. Minister, they intend to fight you and the Premier. They will fight their treacherous local ALP members all the way. Where are the honourable member for Drummoyne, the honourable member for Parramatta, the honourable member for Kogarah, the honourable member for Hurstville and the honourable member for Rockdale? They are not in the House, but they will toe the party line against the interests of their local constituents. They will pay the price for that come the next election.

Among the many concerns raised are the loss of up to 650 jobs amongst existing staff at St George Hospital, pitting nurse against nurse, doctor against doctor, for far fewer positions; and the promised addition of 100 beds is only a net gain of 30 beds, as we have heard from honourable members who have already spoken in this debate, following the Government's closure of 70 beds over the last year. Other concerns include the fact that these extra 30 beds will have to service a much larger population base than that previously serviced by 350 beds at St Vincent's Hospital. That could only be detrimental to existing services provided to the people of St George. There will be the likelihood of much longer waiting lists for surgery. People will have to go to other public hospital facilities and wait a longer time for services; or they will have to take out private hospital insurance - or else pay, if they do not have private hospital insurance - for the use of hospital facilities.

Further concerns relate to the removal of existing obstetrics and gynaecological services, including in-vitro fertilisation, because of the religious beliefs of the new management. I object to the withdrawal of women's health choices. Professor Michael Chapman's superb work has been admired throughout this State and nation, as well as internationally. He and his loyal staff, not to mention all patients who have used the obstetric and gynaecological services at St George Hospital, are shocked by the Minister's proposal. Difficulties will be caused under the new regime for the huge Islamic population in the St George area because of differences in religious beliefs. Will the Halal menu for Islamic patients remain? Will culturally sensitive gynaecological procedures and obstetric procedures remain in place?

The statement of the Minister that the takeover would make St George Hospital a teaching hospital is a joke. The Minister should know that it has been a teaching hospital for years. What sort of Minister is he? Years ago, St George Hospital was facing mounting public criticism due to ALP neglect during the Wran years of government. The remarkable efforts in that decade of staff at the hospital, service and licensed clubs, charities and the wider community have seen St George Hospital become one of the pre-eminent hospitals in Australia. The previous State Government spent more than $200 million to bring St George Hospital up to teaching hospital standard and to ensure its state-of-the-art status in many fields of medicine. All of those achievements are jeopardised by this proposal.

St George Hospital is effectively being privatised - by stealth. The hospital's most important link with the community it serves is to be severed. Over 100 years of effort and tradition, and especially the sacrifice and achievements of the last decade, deserve greater recognition than the furtive and underhanded deal that has been done to kill off St George Hospital. The name St Vincent's may represent a great hospital, and should continue to do so at Darlinghurst in some form. The name St George represents a magnificent hospital and a great community; and I cannot understand how the Minister could regard the name as being of lesser value than St Vincent's. A letter from the St George Hospital branch of the New South Wales Nurses Association to the Premier stated:

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1. Where in your mandate does it give you the legal right to dispose of a public asset, namely a 650 bed public hospital funded by Medicare to a religious charitable organisation?

i) How is this different to the privatisation of Port Macquarie that Dr. Refshauge and your government so vehemently opposed?

ii) Can we expect that further public assets will be disposed of in this way - for example giving the University of NSW to the Catholic College? . . .

5. What right do you have to destroy the 100 year history of the St George district and the identity of the St George Hospital, by a bureaucratic decision made with the stroke of a pen?

6. Under this model will you have us returning to a 15th century moral philosophy heading into the 21st century? How do you justify this when NSW health professes access and equality to all people? This move discriminates against women, ethnic groups and a community that supports the currents philosophy of the St George Hospital.

7. How can you justify handing over St George Hospital to the Sisters of Charity who in their financial responsibilities have managed to lose tens of million of taxpayers money in their bungled management of St Vincents, while St George by the efforts of dedicated staff has shown financial responsibilities in attaining budget each year.

8. Andrew Refshauge publicly guaranteed positions for St Vincents staff at the Kogarah campus, while the staff at St George have been given no such guarantees and have been told that they must reapply for their current position and may be placed anywhere in NSW. Where is the fairness in this decision.

That is what the New South Wales Nurses Association wants to know. This restructure is all about an $80 million cutback in health care to New South Wales residents. Between 1,800 and 2,000 nursing positions will go and 900 beds are to be reshuffled. This is the thanks given to the New South Wales Nurses Association for propping up the Government's failed promise of halving hospital waiting lists, written in blood, delivered by deceptive stealth, manipulation of statistics and coercive tactics against hospital doctors, administrators and the Australian Medical Association. Thank you, Nurses Association. Here is your reward: a kick in the guts.

The New South Wales Nurses Association reminded the Premier and the Deputy Premier of their debt to nurses at Tuesday afternoon's meeting. The nurses will not back down. The citizens' rage and their need for retribution against the Australian Labor Party will not subside. Major decisions and radical shake-ups without consultation have happened before: the role of the Governor, school bus subsidies, tollways, the restructure of agriculture - all fine examples of wonderful decision-making by the Carr Government. David Humphries described it so eloquently in an article in yesterday's Sydney Morning Herald, under the heading "Shock treatment may burn the doctor himself". He wrote:

When Andrew Refshauge boldly unveiled his brave new world for public hospitals last Friday, it was immediately apparent that his consultation had extended to a handful of health bureaucrats, a few political colleagues, his office and the Sisters of Charity, who scored a modern public-funded hospital to give their St Vincent's operation a new lease of life . . .

But the big stuff-up was the Refshauge approach of dropping a whirlwind on an unsuspecting public and a health community with impressive credentials at extracting the maximum pain of retribution on governments which dare to diddle with the holy cow of hospital bed numbers or workplace security of health professionals, particularly nurses.

. . . advice he received from a senior member of staff. "Give it to them hard and fast". . . That way, there would be some public din but it would all be balanced by howls of joy from the Labor heartland, where bed numbers would rise. And, anyway, the changes would be fixed in concrete. That was the theory.

The outcome was a further portrayal of a backdown Government, stung by infidelities of an ungrateful public thumbing its nose at a whole range of initiatives characterised by the same lack of consultation.

David Humphries called it all pain and no gain politics. The article continued:

In Wran-like manner, the Premier has sought to cut short the flow of blood from the ill-advised actions of a senior Minister. It will work for a while but now there is a tougher problem - what to do with hospital restructuring once union expectations have been boosted by the Premier's intervention and their own frontline role in the announced consultation process.

At the end of the day the Minister will not give in. He needs the $80 million savings to balance his "fudge it" budget. It is all part of his social restructuring, his left wing agenda. The morale at St George Hospital is as low as it can be. I suspect some jobs will go. The St George name will go. The community will be turned upside down. Charitable fundraisers to our hospitals will be disillusioned. The health care needs of ethnic groups will be inadequately serviced and women's health options at St George Hospital will disappear. But where are the howls of joy from the west congratulating the Minister, the master of all pain, no gain politics? There will be retribution against those treacherous, local members who have not fully supported St George Hospital nursing and staff members - the Minister for Transport, the honourable member for Hurstville and the honourable member for Rockdale.

Women's health services, sterilisation, insemination and other reproductive health advice and fertility procedures now carried out at St George Hospital under the direction of Professor Michael Chapman will stop once the hospital is handed over to the Sisters of Charity. I am a Catholic, but I am incensed that women in the St George area will have little or no reproductive health options at a public health facility. What response do they get from the Government? They will have to go to another public hospital and wait or they will have to pay to go to a private hospital. The hospital has been sensitive to the needs of the high ethnic population of the St George area. The obstetrics and gynaecology department delivered 2,500 babies last year. Part of the role of midwives was to promote contraception. Plans to expand the IVF program are now halted. Of course, facilities
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such as the transplant unit are welcome at St George but not at the expense of its heritage, staff and the community.

I do not wish to apportion blame to the Sisters of Charity. They were cash strapped and have been in financial difficulties for many years. Naturally they would accept a deal proposed by the Carr Government which would not see the closure of St Vincent's Hospital and from which they would get a $500 million international standard teaching hospital at St George Hospital after merely 2½ weeks of consultation. The community will continue to agitate for two separate hospitals, St George and St Vincents, to fully service their needs. If honourable members ask why there was no consultation with St George Hospital, the answer can be found in the St George and Sutherland Shire Leader of 25 June. I quote Sister Maria from the Sisters of Charity:

Our experience in the past was that we tried a venture like this at Liverpool some years ago and the reason it fell apart was that it got out into the public arena and there was no opportunity to explain what it was all about.

Thus, we have this need for secrecy and deception. A Sydney Morning Herald editorial called on Mr Carr to take the opportunity to explain the rationale of the amalgamation. The editorial pointed out that what was unusual was not the closure of the financially strapped St Vincent's Hospital but the choice of St George Hospital as a hospital for its relocation. The Minister may think that it is all in the bag, but I assure him that the nurses, doctors and staff of St George Hospital, St Vincent's Hospital, Concord hospital and all the other raided public hospitals will go out kicking and screaming, and so will Labor members in the St George area who support the Minister. Mr Premier and Mr Minister, may the Sisters of Charity pray for you all, because the Opposition and the people of New South Wales will not.

Mr DEBUS (Blue Mountains - Minister for Corrective Services, Minister for Emergency Services, and Minister Assisting the Minister for the Arts) [4.24]: At the beginning of debate on this motion the Deputy Premier said that the Liberal Party was interested in defending vested interests in the redistribution of health resources and making a little trouble on the way through. I could not think of a more apt characterisation of what has been going on. In the period of the Liberal Party National Party coalition there was a constant stream of hospital closures - 30 were closed during that time. At the same time, little enough was done by way of redistribution of resources to western and south-western Sydney, the Illawarra and the Hunter. The Nepean Hospital, I recall, was the object of a promise by the former Government of 120 beds. Those 120 beds were never properly funded.

Following on the initiatives of the previous Labor Government, the Nepean Hospital was, to a degree, rebuilt but it was a building that contained no services. Under the previous coalition Government there was not adequate funding of the services necessary to provide anything like equitable health resources in western and far western Sydney, notwithstanding the protestations of the Leader of the Opposition, among other people, who constantly claims that somehow or other he invested beds in the west. During the debate Liberal Party members have described the redistribution of health resources in this State as left wing social engineering. They should speak to the honourable member for Bligh who thought it was economic rationalism. They should make up their minds about how they wish to characterise this redistribution of resources. I would characterise it as fairness, social equity, reasonableness, appropriate administration and nothing to do with either social engineering or economic rationalism.

Residents of central Sydney receive 1,152 health dollars per capita and have 5.1 beds per thousand population. Residents of the south-eastern Sydney region receive 955 health dollars per capita and have 5.5 beds per thousand population. In comparison people in my area of Wentworth receive 509 health dollars per capita and have 2.6 beds per thousand population - half the number of beds compared with central Sydney. In south-western Sydney the figures are even worse as the people receive 471 health dollars per capita and have access to 2.5 beds per thousand population. In 1994-95, 11,400 patients from south-western Sydney travelled to central Sydney for care; 8,700 travelled from south-eastern Sydney for care; 10,500 patients from the Wentworth area travelled to western Sydney for hospital treatment; 1,500 went to south-eastern Sydney; and 1,500 residents went to central Sydney for their hospital treatment.

The honourable member for Bligh and the honourable member for North Shore do not appear to accept the implications of these figures. Their communities have the choice of a plethora of hospitals to attend for a plethora of services within a few minutes' drive from where they live. Approximately 72 per cent of patients leave the Wentworth Area Health Service area for tertiary treatment and 38 per cent of the patients go outside the area for non-tertiary treatment. That amounts to 23,000 people each year who have to leave their local area to receive what is essentially routine medical treatment. The changes under debate today will finally address that inequity.

Having heard the debate, I am not sure whether those opposing these changes understand the full, human implications of this maldistribution of health resources. Recently, I had the melancholy experience of sitting in the surgery of a practising specialist doctor in Katoomba in the upper Blue Mountains and all day we interviewed cancer patients. Most of those patients were women suffering from breast cancer and none was able to have treatment west of Westmead. They were all being treated at Westmead Hospital, Royal Prince Alfred Hospital or the Royal North Shore Hospital. Many of them travelled daily 50, 70, 100 kilometres each way to receive chemotherapy. Many of them
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travelled by public transport and others were driven by their now elderly and frail husbands. I received a letter from a constituent who described to me the sequence of cancer-related conditions that his wife had suffered during a period of 18 months and a description of the travel they undertook to have effective treatment at Westmead Hospital and at other hospitals in the inner city. The husband calculated that in a year and a half he had travelled the equivalent of two and a half times the distance between Sydney and Perth in order to have what ought to be routine cancer treatment.

The honourable member for North Shore spoke about various hospitals she had visited and had been impressed by - hospitals which were now affected in one way or another by a loss of resources in the redistribution proposed by the Government. I suggest she and others should visit the casualty ward at a hospital such as Nepean Hospital or Liverpool Hospital and see what that is like on a Friday night, Saturday afternoon or a Sunday morning. She will not only be impressed by the dedication of the staff but by the extraordinary difficulties they have coping with the resources that they are presently forced to apply to the case load: there is no comparison. Visit an overloaded western Sydney hospital and then dare to oppose these changes!

I am sorry to focus on the remarks of the honourable member for North Shore but I happened to listen closely to what she said and she is, apparently, the representative of the Opposition on these matters. She made ridiculous attacks on the proposed reductions at Westmead Hospital. Approximately 27 per cent of the patients treated at the Western Sydney Area Health Service - for the most part at Westmead Hospital - are from the Wentworth and south western Sydney area health services. It does not take a mathematical genius to work out that if Liverpool Hospital, Nepean Hospital and Hawkesbury Hospital are expanded then possibly the numbers of beds at Westmead Hospital can be reduced. The spurious and dishonest propositions put by a series of coalition speakers with respect to this self-evident truth gives the lie to the seriousness with which most members opposite take this debate.

The honourable member for North Shore did not seem to understand that Westmead Hospital is a long way from the Nepean Hospital at Penrith. It is further than Kogarah is from Darlinghurst. The member for Penrith, the Minister for Fair Trading, and Minister for Women, has told me on several occasions some truly appalling stories about the reality of medical treatment in the Penrith area. She has told me, on the authority of doctors who have seen the events I will describe, of numbers of poorer, less well-off women who have accepted a mastectomy operation at Penrith rather than have to travel daily to Westmead Hospital to receive necessary chemotherapy or radiotherapy. At present young women in Penrith are choosing to have a breast removed, rather than have chemotherapy, in the hope that they can continue to look after their children and conduct their lives. They are making that choice because it is physically too difficult to get to the only hospital providing the therapy. Just as well the Government is building a new cancer treatment centre at the Nepean Hospital to provide chemotherapy and radiotherapy services.

I ask those concerned about access to IVF at the St George Hospital to do as Professor Hall suggested in the Sydney Morning Herald this morning and ponder this fact: there is no publicly-funded IVF program in south-western Sydney at all. There has not been funding for an IVF program. Match that circumstance with the complaints of the honourable member for Georges River and others. The matters we are discussing are not new. In my own experience they have been under debate and a matter of contest since the early 1980s. For a generation now thousands of people in the western suburbs have been denied basic health services that the people of the north shore and eastern suburbs have enjoyed during that time and before.

For the first time, under this process of redistribution the people of Liverpool and Penrith will have properly funded beds in teaching hospitals that they can be proud of. In my electorate of Blue Mountains there will be improved services, these in turn building upon a $6 million refurbishment that is already in planning. There will be paediatric services and improved neonatal services, which will mean that far fewer of my constituents have to travel from, say, Katoomba to Nepean, Westmead or Royal Prince Alfred hospitals. The Minister has properly emphasised the improvements he proposes in community health. I point out that, during the period of coalition government, in my electorate the number of allied health workers and nurses employed in community health centres declined. Between 1988 and 1995 the number of full-time equivalent community health workers actually declined, even though the general population, the number of children and the number of older people were increasing.

The hospital improvements and the community health improvements represent the triumph of the debate of a generation. The initiatives that I have described will dramatically improve the quality of life of people throughout western Sydney. The people of the western suburbs and the Blue Mountains will have vastly improved access to local services. It is not fair that the 30,000 people from south-west Sydney and the 14,000 people from the Blue Mountains and Nepean areas were forced to seek medical treatment in the inner city last year. The rapid growth of the western suburbs is at last being matched by growing funding for necessary health services. Nobody can tell me that that is not a good thing. [Time expired.]

Mr O'DOHERTY (Ku-ring-gai) [4.39]: It was touching to hear the Minister for Corrective Services and Minister for Emergency Services speak about the need to allocate beds where the people are
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in Sydney. The Greiner and Fahey governments began the much overdue move of beds to the west. The honourable member who represented and lost the seat of Blue Mountains in that era knows full well that the Wran Government did not provide services where the people were. Nobody denies the need to place services where the people are; the previous two coalition governments did that. This debate is not about a movement of beds to the west; the changes involve an overall cut to the health budget of New South Wales of $80 million with 2,000 jobs to go - 900 nurses and 500 beds lost from the system. As the honourable member for North Shore said, on the road to wherever the Government is going, a lot of money has been lost.

Labor members have focused on how well off their electorates will be under the new arrangements. Surely they can understand that if their Government was not taking money out of the system at the same time as dressing the changes up as a movement from one place to another the whole State would be better off. But as it is the whole State is worse off. In my contribution I want to focus on Neringah hospital. It is one of the four hospitals that will be closed by the Government. The Government has claimed, in the case of some of the other hospitals, that they are not closing; they are changing location or moving from one type of hospital to another. There is no argument that the Minister for Health made a decision in the last couple of weeks to close Neringah hospital in Wahroonga lock, stock and barrel. The 70 beds will go and the doctors and nurses will work somewhere else. The whole hospital will finish. It will cease operating on its site in Wahroonga, where for a very long time it has been a leader in the care for the dying, the aged and the disabled.

The hospital has a proud tradition and is part of the community, the average age of which is probably increasing at a rate greater than that of the State in general. The Minister, in his mickey mouse, mealy-mouthed defence during question time, mumbled something about having to move some palliative care to the peninsula. The facts are these: Neringah hospital will close. Some beds will move to Hornsby hospital, which I will come back to in a few minutes. According to the 1991 census the aged in the Hornsby and Ku-ring-gai area make up about 13 per cent of the population, and the percentage is growing rapidly. Yet half the palliative care beds in my area of Hornsby and Ku-ring-gai will be taken away by the Minister. By the year 2040 aged people will represent more than 25 per cent of the population.

Twelve beds will go to Manly, meaning a net loss for the Northern Sydney Area Health Service of eight beds in palliative care. As the honourable member for Manly pointed out, the peninsula, together with my area, has an increasingly aged population which depends on these services. The Minister has no commitment to palliative and aged care and this move proves it. Another example is the net loss of 10 rehabilitation beds in my area. Aged people in my community, following a stroke or other serious illness, with the necessary training provided by Neringah hospital, could return to their homes to live with their remaining faculties. Without the hospital's services, people who have suffered serious illness will not be able to return to live with their families or in their own homes.

The Minister wants to shift the costs from his budget to the Federal Government, increasing the pressure on nursing homes and other supported care accommodation in the North Sydney area. The quality of life of aged people in my electorate who depend on these services has been diminished by what the Minister has done. This clearly represents a broken promise by the Carr Labor Government. In its 1995 manifesto it said that no hospital would be closed - not one. Even if the Minister could argue about the other three hospitals which are being closed as a result of his announcement last week - saying that they are not being closed, just changed a bit - there can be no argument about Neringah hospital. Not only have the people of New South Wales been lied to; the board of the hospital, the Hope Healthcare Group board, has been lied to. It has been negotiating with the Northern Sydney Area Health Service for some time about the possible future of the hospital under the brave new world of cuts brought in by the Carr Labor Government.

The board's understanding, before the Government's announcement last week, was that there would be discussion about the consolidation of rehabilitation, aged care and palliative care services for the Hornsby and Ku-ring-gai area to take better effect at Neringah at Wahroonga and that there would be discussion about the willingness of the board to consider, along with its preferred option - the one I have just mentioned - the consolidation of some services at the Hornsby hospital campus, with Neringah continuing on Hornsby hospital campus under the Hope Healthcare Group. The board was shocked by the Government's announcement last week that Neringah hospital will be gone - that is the end of the matter. Urgent discussions are now taking place between the Hope Healthcare Group board and the Northern Sydney Area Health Service as to the Government's intentions for Neringah hospital on either the Hope Healthcare campus or the Hornsby and Ku-ring-gai Hospital campus.

It has been suggested that Neringah hospital may be able to continue on the Hornsby hospital site. That is simply a press release trick; it is rhetoric. Once the Government closes Neringah hospital - which brings together on one campus the best in Australia of palliative care, aged care, and rehabilitation services - the dynamic of that hospital and the culture of care provided will be gone forever; they cannot be reproduced on another campus. If the services are transferred to Hornsby and Ku-ring-gai Hospital the same people will not be involved; they will be gone forever. The Hope Healthcare Group has operated palliative care facilities in New South Wales since 1907. It has a 90-year tradition of caring for dying patients and the elderly.

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The Hope Healthcare Group began when two people found a cancer patient in a Sydney park with nowhere to go. In 1907, they established the Home of Peace, which grew into the Hope Healthcare Group. The group is now one of the larger, if not the largest, providers of palliative care in New South Wales. It has an excellent, Australia-wide reputation as a leader in palliative care. Neringah hospital has a long association with care for the aged and the very sick. Indeed, it began as the Red Cross Convalescent Hostel. It is known to many Second World War returned service men and women, and it has a special place in the heart of my community of Hornsby and Ku-ring-gai. When demand increased for the services provided by the Hope Healthcare Group at the Eversleigh Home of Peace for the Dying at Petersham in the 1950s, the group decided to extend its operations to the north shore.

In 1954 the group opened its second Home of Peace for the Dying on the site of the Neringah Red Cross hostel, where it currently stands. It opened with 12 beds in what is now the administration block; it now has 70 beds on a well-utilised site. A building program in 1952 and subsequent programs have meant that it is an up-to-date facility providing the best care. There is a straight-line history between Neringah hospital and care for the very sick, convalescing patients and the dying. There is also a straight-line history between the Hope Healthcare Group, which currently operates the site, and care for dying patients in our community. The Minister has turned his back on that history, which will be lost forever when the hospital is closed by the Carr Labor Government. Hornsby and Ku-ring-gai Hospital, as part of the Northern Sydney Area Health Service, does not receive a fair share of resources. The transfer of palliative care and other services to Hornsby and Ku-ring-gai Hospital will place an additional burden on that hospital at a time when its facilities should be expanding, not contracting under the additional burden of palliative care.

Hornsby and Ku-ring-gai Hospital is facing a cut in its operating budget of 3 per cent - that is probably a cut of $1.3 million in the budget for acute care services. This major hospital, which covers 250,000 people or one-third of the population area of the Northern Sydney Area Health Service and one-half of the geographical area, does not receive a fair share of resources. Access to emergency services, acute care services, maternity services and other services provided by Hornsby and Ku-ring-gai Hospital must be maintained for those who depend on that hospital. The Opposition seeks an assurance from the Minister that he will not cut the budget for Hornsby and Ku-ring-gai Hospital, but will enhance it.

When Labor came to office the Minister stopped the redevelopment of Hornsby and Ku-ring-gai Hospital. It is a disgrace. Redevelopment of the hospital, which provides important health services for not only North Sydney but New South Wales generally, is overdue. The redevelopment was approved by the Fahey Government but it has been stopped by the Carr Government. The hospital needs upgrading, not downgrading. In the context of debate about Neringah hospital and the loss of half the palliative care beds in the Hornsby and Ku-ring-gai area, I ask this question: what does the announcement say about the commitment of the Carr Labor Government and, in particular, the Minister for Health to palliative care in New South Wales? I also ask that question deliberately in the context of debate on euthanasia.

The Minister for Health is on the record as supporting euthanasia legislation. That is his private position. I presume that if legislation was introduced, and if there was a conscience vote on it, the Minister would vote in favour of euthanasia as an option in New South Wales. It has been said that if the Northern Territory had had palliative care facilities, let alone proper palliative care facilities, euthanasia legislation would not have been enacted. The best way to stop euthanasia legislation from proceeding in New South Wales is to ensure, firstly, that people understand the nature of the debate - it is not only about turning off machines if people are vegetables - and, secondly, that the Government provides adequate palliative care facilities to enable those people to die with dignity.

The Minister's decision to close half the palliative care beds in Hornsby and Ku-ring-gai Hospital raises an ominous question about his commitment to palliative care and, therefore, the Government's commitment to ensuring that palliative care is maintained as a proper option in New South Wales, rather than providing a slippery slope - a funding-induced move to euthanasia legislation in New South Wales. For those reasons, and because the Government is closing care services for people in my community, the Minister not only deserves to be censured by the House; he lacks the confidence of the House to continue to provide services for the people of New South Wales in an honest and open way into the future. There was no consultation with the hospital board or the community. [Time expired.]

Mr IEMMA (Hurstville) [4.54]: I am glad that the honourable member for Ku-ring-gai concluded on the issue of consultation. I have much to say about the Liberal Party's version of consultation when in government. I am glad that the honourable member for Georges River is in the Chamber, because I have much to say about the consultation process relating to Canterbury Hospital, which affects her electorate as much as mine. Honourable members remember the consultation process undertaken by the former health Minister, the Deputy Leader of the Opposition, in relation to Canterbury Hospital. The coalition Government paid consultants $400,000 to recommend the best site.

Honourable members recall the community consultative committee that was established, at a cost of $75,000, to recommend the best site for the new Innerwest Hospital. That commit
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recommended that the new Innerwest Hospital be built at Canterbury. However, the former Minister for Health ignored that recommendation and said that it should be located at Strathfield. A medical consultative committee recommended that the new Innerwest Hospital should be built at Canterbury, but the former Minister ignored that and said that the hospital would be built at Strathfield.

Ms Ficarra: The honourable member is ignoring all his St George constituents.

Mr IEMMA: I shall come to them in a moment. PPK Consultants Pty Limited was paid $54,000 to recommend the most appropriate site. What did the previous Government get for that $54,000? It got the same recommendation as the community consultative committee and the medical consultative committee. PPK Consultants rated Canterbury as the best site. PPK rated Strathfield number six. The former Minister dumped its recommendations; he ignored them. Instead, he said that the hospital would go to Strathfield, to shore up the electoral prospects of Paul Zammit.

The nurses and other health workers said that they wanted Canterbury, but the Minister decided on Strathfield. Again he ignored their recommendations and their views. The process of consultation was dumped because the Minister had made a predetermined decision that Paul Zammit had to be helped in Strathfield, as he was under pressure. The hospital was going to Strathfield! After all that consultation came the classic decision: $61,000 of taxpayers' money went to a former member of the Minister's staff to undertake market research on the most appropriate site for the new Innerwest Hospital. Not surprisingly, given his background, he came up with Strathfield. The Minister jumped at that and said that community consultation had occurred and had indicated that the people demanded Strathfield and that the Government would put the new hospital at Strathfield.

However, the market research never asked the people about a site at Canterbury. During the consultation process Canterbury was never put to the people. That is consultation in the style of the Deputy Leader of the Opposition. That is consultation courtesy of the previous Government. That is the previous Government's legacy of consultation about the health budget and various health services. That is the previous Government's form of consultation when it comes to distributing the health dollar in New South Wales. That is the model of consultation that the former Government left. Of course, that is not all it left: it also left a trail of closed hospitals and closed hospital beds that will stand forever as a record of mismanagement. It is important to put on the record all the hospitals that were closed by the Deputy Leader of the Opposition and the Leader of the Opposition when they were health ministers: Western Suburbs Hospital - closed; Wallsend District Hospital - closed.

Ms Ficarra: You guys closed Western Suburbs hospital; don't blame us.

Mr IEMMA: The former Government demolished the Western Suburbs Hospital. The honourable member should read the newspapers. The former Government could not get rid of the Western Suburbs Hospital quickly enough and could not demolish it quickly enough. For the benefit of the honourable member for Georges River I will repeat that: the former Government closed and demolished the former Western Suburbs Hospital, and the hole in the ground is there courtesy of the coalition Government. Parramatta Hospital, Kiama District Hospital, Yeoval Hospital, Glebe hospital, Binnaway hospital, Royal South Sydney Hospital, Chatswood District Community Hospital, Lidcombe Hospital, St Josephs Hospital, Eversleigh Hospital, Balmain Hospital, Royal Newcastle Hospital - all were closed.

Port Macquarie hospital was privatised. What happened to the public hospital at Port Macquarie? It has gone! Hawkesbury Hospital, Mosman and District Community Hospital - closed; and the list goes on. In addition, there were 5,000 fewer beds, the equivalent of another 15 hospitals. That is the former Government's legacy. In her contribution the honourable member for Georges River - shock, horror - said that people in her electorate might have to go to another hospital in the area. That is true. The action taken by the present Minister for Health means that her constituents will get an opportunity to go to a new hospital at Canterbury, the Innerwest Hospital. The former Government was never going to build that hospital; it was going to close it. Contrary to the lies and misrepresentations of the member for Georges River, the shadow minister, and other members, an increase in services is proposed for St George.

The honourable member for Georges River might not like that, and that is understandable, because the former Government, of her political persuasion, had seven years to make sure that the residents of the inner-south had access to decent medical services and the latest technology in local hospitals, at Canterbury as well as Kogarah. That is integral to what this Government is providing: an increase in services at St George Hospital at Kogarah and also a new hospital at Canterbury which, if the coalition had won the election, the constituents of Georges River would never have had. The former Government would have ripped the guts out of St George Hospital long ago. This Government is about increasing services at St George Hospital. The St George and Sutherland Shire Leader, the favourite newspaper of the honourable member for Georges River, contained an article.

Ms Ficarra: Is that your favourite newspaper?

Mr IEMMA: It is. Part of the former Government's legacy to the people of St George, something that the proposals by the Minister for Health will change, was mentioned in the newspaper article, which stated:

Page 3816

The cardiac unit at St George Hospital has cancelled elective surgery because it has no more money. Nine patients scheduled for operations this week in the cardiac laboratory were told the unit had closed indefinitely.

That was 24 November 1994. Part of what the Minister for Health has proposed will result in additional cardiology services and cardiothoracic facilities at St George Hospital. The honourable member for Georges River had plenty to say about the loss of 160 beds at Concord hospital. The honourable member lied, because 60 of those beds at Concord belonged to Canterbury Hospital. They comprised the Canterbury Hospital wards, the facilities that belonged to the people of Canterbury, the inner-west and the inner-south-west. They are the honourable member's constituents as well. It is important to put on the record that the honourable member for Georges River does not want those beds to go back to Canterbury. Those beds belong at Canterbury, they came from Canterbury while the construction was continuing. They were always to go back to Canterbury when the new hospital was built so that her constituents could benefit from a new hospital, just like my constituents will. But the honourable member does not want them to go back. The Deputy Leader of the Opposition and all Opposition members who spoke in this debate do not want them to go back.

Mr O'Farrell: That is unfair.

Mr IEMMA: I am glad the honourable member has put that on the record. He does not want the people of Canterbury and those constituents who live at Penshurst and Mortdale, for whom Canterbury would be a handy hospital, to go to that hospital.

Ms Ficarra: They go to St George.

Mr IEMMA: The honourable member for Georges River does not want those beds to go back. She never wanted the new hospital at Canterbury, she never wanted additional services at St George; she simply wanted to transfer them away from her region. And, of course, I should not forget the Opposition's model for New South Wales at Port Macquarie.

Mr O'Farrell: What about Liverpool?

Mr IEMMA: Liverpool gets an extra 240 beds. Port Macquarie hospital was the model that the former Government wanted for New South Wales. It is an absolute lie that the proposal for St Vincent's Hospital and St George Hospital is in some way privatisation. Port Macquarie was privatisation.

Mr O'Farrell: What is this?

Mr IEMMA: This is a public hospital at Darlinghurst and a public hospital at Kogarah. This is not flogging off the assets; the Government will not own the assets. We will not have a situation like the one at Port Macquarie on which the Auditor-General reported. His report stated that the Government is, in effect, paying for the hospital twice and giving it away. That was the coalition's model, but that is not what is happening here. St Vincent's is a public hospital merging with a public hospital at Kogarah to become one of the hospitals of excellence in this country. Honourable members opposite are opposed to that.

Ms Ficarra: It already is.

Mr IEMMA: It will be added to. Does the honourable member suggest that services provided by St Vincent's Hospital will not add to the excellent services provided by St George Hospital? According to the honourable member that is so, but that is not surprising.

Mr DEPUTY-SPEAKER: Order! The member for Georges River has had the opportunity to contribute to the debate. She will refrain from interjecting.

Mr IEMMA: It is not surprising that the honourable member for Georges River would take that view. She would deny the residents of the inner-south the Canterbury Hospital. She did not want it there. She wanted it shut. Now she does not want the 60 beds at Concord that rightfully belong to those residents, as well as her constituents, to go back to Canterbury. I am glad she has been flushed out. This proposal is about improving the excellence at St George by maintaining the standards of excellence at St Vincent's and bringing them to St George Hospital. The Minister has made it absolutely clear that the name of the hospital has not been decided on. He is taking representations in that regard. I am sure that ultimately the name will reflect the history and traditions of both hospitals and the St George area. Misrepresentations from the other side are nothing more than feigned indignation and crocodile tears for people for whom honourable members opposite have never had any consideration. I am glad that the honourable member for Georges River has put on record that she does not want the people of her area to get the beds that rightfully belong to the hospital at Canterbury.

Ms Ficarra: Prove it.

Mr IEMMA: The honourable member said it in her speech. It will be in Hansard tomorrow for everyone to read. She does not want those beds. She does not want the wards at Concord, which are called the Canterbury wards, to go back to Canterbury. [Time expired.]

Dr REFSHAUGE (Marrickville - Deputy Premier, Minister for Health, and Minister for Aboriginal Affairs) [5.09], in response: I thank all honourable members who have contributed to the debate. A whole range of issues have been raised by members on both sides, but the simple question is whether they believe in fairness and equity of funding in the health care system. Obviously, honourable members on this side of the House believe in fairness and equity in the public health system; but honourable members opposite do not.
Page 3817
The furphy about funding is very clear. On page 9 of Budget Paper No. 5 for 1994, the last column reflects that the health care budget for that year was $3.8 billion. In the first Carr budget, as shown at page 10 of Budget Paper No. 5 for 1995, the health budget was $4.2 billion.

This year, looking at page 11 of Budget Paper No 5, the health budget is $4.3 billion. That is a 13.7 per cent increase in dollar terms, almost a 7 per cent increase in real terms, since Peter Collins was the Treasurer of this State. All the issues raised by the Opposition have been dealt with effectively by honourable members on this side of the Chamber, but I would like to raise a couple of points. It was very unfortunate that the honourable member for Ku-ring-gai tried to suggest that my personal view of euthanasia would influence me to specifically reduce palliative care beds throughout this State. I found those comments very offensive and unbelievably insensitive to the issue of aged care. I hope that at a later stage he will retract those comments because they demean him and this Chamber.

Mr O'Farrell: But you have reduced services.

Dr REFSHAUGE: Services in palliative care this year have increased, as they increased last year. The Government intends to continue to provide -

Mr DEPUTY-SPEAKER: Order! The member for Northcott will refrain from interjecting.

Dr REFSHAUGE: The other issue of note is that only one speaker from the National Party, its leader, contributed to the debate. No-one else from the National Party was prepared to speak. Its members know that what the Government is doing is right, that it is heading in the right direction, and that they are getting a better deal in health under a Labor Government than they ever got under the former coalition Government. For example, the hospital at Dubbo will be rebuilt, the hospital at West Wyalong will be rebuilt and a new hospital will be built at Coffs Harbour. Time and again the National Party had promises from its Liberal colleagues, but they could not deliver. The Labor Government is delivering not only to the growing metropolitan areas and the great regions of the Illawarra, the central coast and the Hunter, but also to rural New South Wales. It is clear that the National Party supports the Government in this instance because it knows that its constituents will benefit. It will be interesting to see how some members vote, particularly the honourable member for Gosford, who in interjections has said he does not want services to be enhanced in Gosford.

Mr Hartcher: Because you won't put in a linear accelerator that you promised the people of the central coast.

Mr DEPUTY-SPEAKER: Order! The member for Gosford will refrain from interjecting.

Dr REFSHAUGE: If the honourable member for Maitland votes in favour of the motion, he will be saying that he does not want his hospital in Maitland to be fully functional. That is a very interesting position to be put in, and I understand it. I was surprised that he did not look for a pair to try to square away with his mates, but he was prepared to put himself on the line and we will see what happens. It is interesting to note that when the former Government closed the Royal Alexandra Hospital for Children at Camperdown and rebuilt it at Westmead, the Labor Party supported it. We did not play politics. We could have tried to undermine it, but we did not. Instead we said, "Yes, this is the right direction, this is the way to go." The consultation process undertaken by the former Minister was very similar in the early stages. With the total support of the Labor Party Opposition he announced the proposal with minimal discussion with the community, then had further discussions at a later stage.

I would have thought that if the coalition had any credibility and any commitment to the growth areas of this great State of ours, it would have supported this move of resources to growth areas. Every one of the 10,000 patients travelling from Nepean to Westmead, every one of the 10,000 patients travelling from Liverpool to Westmead and every one of the 18,000 patients travelling from the central coast to access health services knows that the Government is moving in the right direction. Whether it be a cancer patient in the Illawarra or in the Hunter, or a cardiac surgery patient in Liverpool, everyone knows this is the way to go. There is no doubt that this debate is about equity and fairness. This side of the House believes in equity and fairness and it will reject the motion.

Mr COLLINS (Willoughby - Leader of the Opposition) [5.25], in reply: This debate is not about equity and fairness, but about honesty. This debate is about ensuring that in future there is greater consultation than has occurred in this case. The strongest motion of condemnation this House can move against a Minister is a no-confidence motion, which the Opposition has moved against the Minister this afternoon. I am fascinated that the Minister chose the children's hospital as an analogy. He claimed that when the coalition transferred the children's hospital from Camperdown to Westmead the Labor Party supported it. Of course the Labor Party supported it; the entire community supported it. The coalition consulted people before the move was announced. We talked to the experts, determined the demographic centre of Sydney for the location of the hospital, and that is where we put the hospital. We did not determine it according to some sort of political agenda or to suit political boundaries. We put the hospital at Westmead because that is where it belonged. It could serve a million Sydney children better than the old children's hospital at Camperdown. The coalition went further. Not only did we consult people but we provided total replacement. There was no game or trick involved. We did not decide to shift the children's hospital and not fully rebuild another.

Page 3818

Before the event we consulted the children's hospital administration and asked whether, if a brand new children's hospital were built and all of their services and staff transferred to it, they would go. They said "Yes, we will go." That is exactly what happened. That stands in distinct contrast to this shifty move, this huge privatisation which has occurred without any call for expressions of interest, and this pathetic attempt to camouflage the closure of St Vincent's Hospital as we know it. The Carr Government told the people at St Vincent's Hospital that provided they sign up very quickly, do not make any fuss and do not argue, all the jobs at St Vincent's and St George hospitals would be thrown open, St Vincent's would switch over to St George, the Government would stick a new name on the door, run St Vincent's Hospital down to 100 beds and pretend that everything was the same.

These changes are about turning two teaching hospitals into one. They are about an emasculation of one of the medical icons of this country: Vincent's Hospital. The proposal involves the withdrawal of critical services from that excellent teaching hospital campus at Darlinghurst, one which has few parallels in the western world and fewer parallels in this country. During this debate the House has heard plenty from Opposition members and the Independent members for Manly and Bligh. What about the people outside? What about the third parties to this dispute whom the Deputy Premier, and Minister for Health, denies? Debora Picone, executive director of the New South Wales College of Nursing, said:

At a time when nurses and doctors should be concentrating on caring for the sick, many will now be faced with the task of dismantling world-class health care services.

The decision to close and downgrade services prior to establishment of new services are the fundamental flaw in the Government's plan.

We have lost many of our most experienced intensive care, operating room and emergency department nurses over the past 12 months.

Dr Andrew Byrne wrote in a letter to the Sydney Morning Herald:

The decision to close St Vincent's Hospital is a great tragedy. Centres of excellence just cannot be moved like caravans. And St Vincent's is a world-class centre of excellence.

Annmarie Kaan, the Nurses Association representative from St Vincent's, said:

No matter what the outcome of this whole shemozzle is, the spirit will never be the same.

Bruce Thomas, a potential benefactor and a patient of St Vincent's who was operated on by Dr Victor Chang eight years ago and owes his life to that hospital, has withdrawn $1.5 million in a proposed bequest to that hospital. He said this:

I'm not happy they're taking our hospital away and I'm not happy at all with the way it's been handled.

Kate Blake, a cardiothoracic nurse educator at St George Hospital, wrote in a letter to the Sydney Morning Herald:

I would like to place on the record how appalled I am by the decision to rename St George to St Vincent's. . . . The way it was announced last Friday that our name was to be changed was most distressing and disturbing to the staff I have spoken with.

Who gave Dr Refshauge permission to give our public hospitals away?

She concluded, and the Opposition concludes:

Hands off St George.

Kogarah mayor Tom Lind said:

There has been no consultation with the council about the Government's plans for the merge and we are worried that local nurses at St George Hospital will lose their jobs.

Associate Professor Stuart Renwick, Director of the Sydney Breast Cancer Institute, writing to the Sydney Morning Herald about the closure of Rachel Forster Hospital, said:

. . . the hospital has a very strong tradition of providing service to the women of NSW. It was opened in 1922 to train women doctors . . . and was enlarged in that role in 1941. In 1952 the first breast clinic in Australia was opened by Dr Kathleen Cunningham and in 1955 Dr Margery Dalgarno began to take the first Australian mammograms.

He concluded:

I trust it is not too late to reconsider this decision.

Annette Sachse, a registered nurse with six years' experience at Neringah hospital, said:

It's wrong, it's disgusting, it's sad. We are going full circle to what was happening when I was training in 1966.

A Manly hospital nurse was quoted in the Manly Daily as saying:

If anything happens to a tourist who can't swim at Manly beach it is a hell of a long way to Mona Vale Hospital. And if a child breaks his arm on a set of monkey bars and comes to Manly Hospital what will he get? A little pain relief and then be sent all the way to Mona Vale. We all realise the Government has no money and no commitment to health but what we want is a public health system for everyone.

Sandra Moait, the head of the Nurses Association, said:

If consultation is important now, it was doubly so before the announcement.

The anger and cynicism and despair of nurses is absolutely palpable.

This is almost beyond belief - it makes an absolute mockery of the State Government's claim that they wish to provide better health services when they are actually cutting them.

Peter Sams, Secretary of the New South Wales Labor Council, said:

The Government has underestimated the response from the community and unions.

An unnamed Labor backbencher was quoted in the Australian today as saying:

There are heaps of rumblings, heaps of them.

Page 3819

There are quite a few members on the Labor side we have not heard from today, and there are some very conspicuous absences. I will come to those later. Another Labor member of Parliament said:

This is just another example of the Government taking a major decision with a negative impact on many thousands of people without consulting either the ministry or the Caucus.

Piers Akerman said in today's Daily Telegraph:

The bulk of hospital resources in the west were placed there by previous Coalition governments.

Labor has left its indelible mark in the west with its pre-election promise to remove tolls on the freeways.

Destroying hospital jobs in the west to relocate the displaced St Vincent's staff will not be forgotten at the next election.

David Humphries observed in today's Sydney Morning Herald:

. . . the big stuff-up was the Refshauge approach of dropping a whirlwind on an unsuspecting public and a health community with impressive credentials at extracting the maximum pain of retribution on governments which dare to fiddle with the holy cow of hospital bed numbers or the workplace security of health professionals, particularly nurses.

That is what a few outsiders have said. It is obvious that those are views shared by many members of the Labor Party who have not spoken in this debate. A rally will be held at St George Leagues Club tonight which will be attended by an overwhelming number of staff members from St George Hospital and, I trust, will be well supported by the people of the St George community. I will be there, the honourable member for North Shore will be there, and the Deputy Leader of the Opposition will be there. I have no doubt though that the Deputy Premier, and Minister for Health will not be there, and I have no doubt that one would have to scour the crowd or scour a several kilometre radius of that meeting to find a single member of the Australian Labor Party. They are running scared on this issue - and run scared they should, because this debate is not about shifting resources.

The shift of resources was put in place a decade ago. The previous Government contributed substantially to that shift in resources during its seven years in office, but that is not the issue. It is not a matter of going back to some greenfields site in this State and saying, "Let us work out how we can reshuffle the hospitals." Hospitals such as St Vincent's are where they are because we live in the greatest city in Australia, and the greatest city in Australia is also the best-resourced health centre in Australia. That is because of hospitals such as St Vincent's, which has built up a tradition during the past 130 years. The Labor Party is seeking to turn its back on that tradition and to turn its back on those resources.

This proposal is designed to cut health services. It is designed to meet a budget priority which has been given to the Minister by the Premier and by the Treasurer. He has been told that the Government has to cut $80 million from the health budget. That will mean the loss of 2,000 jobs for health professionals and the loss of 500 beds from the hospital system. It will effectively wipe four hospitals off the map. The first is St Vincent's Hospital, and it will be to the Labor Party's everlasting shame that it is the Government that has attacked St Vincent's Hospital and taken it off the map of medical services that this State has to offer. The others are Manly hospital, Rachel Forster Hospital and Neringah hospital. The Minister for Health will go down in history as the terminator, Arnold Schwarzenegger without the muscles.

It is no wonder that Sydney cartoonists, who usually get the picture pretty quickly, have portrayed the Premier as a blood-spattered surgeon and the Minister for Health as a morgue attendant. The Carr Government has broken six key election promises by making this decision. The Labor Party could not run the hospital system in the 1970s and 1980s and it cannot run the hospital system in the 1990s, except into the ground. The Minister stands condemned by health professionals and by members of his own faction, who are in open revolt with the Minister, who was not prepared to get the consent of Cabinet, and who was not prepared to run this decision past his caucus, except those parts of his caucus that he thought he could get away with. It is quite obvious that the Minister's idea of consultation is asking his press secretary what time his press conference is scheduled for.

The announcement was leaked by the Premier's office because the Premier needed a distraction from his own appearance before the Independent Commission Against Corruption last Friday. The Minister for Health went into damage-control mode, running around trying to make explanations because his leader was daft enough to try to create a diversion from his personal appearance on the footpath at Redfern as he went to try to explain himself to the ICAC. I note that the Premier, who has a reputation for stabbing his Ministers in the back, did not leap to the Minister's defence today. The Minister for Health now has a lot in common with the Minister for Community Services in another place, who has been stabbed in the back and in the front in the past few days. As this parliamentary session draws to a close, the Carr Government is well defined by its deceit and dishonesty, and by its attempt to pull the wool over the eyes of the electors.

This issue will haunt the Carr Government for as long as it remains in office. If the community had its say about this motion, it would be carried resoundingly because it deals with a massive dislocation of services that the community has come to depend on. The services are overstretched and always in great demand; they are not always available when and where people would like them. Nevertheless, they are services people rely on. As this parliamentary session ends the Government is smugly prepared to try whatever deceit, deception
Page 3820
and lies it can get away with; the arrogant, complacent Government is prepared to try a stunt such as this simply because a few weeks ago it picked up a seat in a by-election that it did not expect to pick up. This is the kind of smugness which the electorate will reject; this is the kind of dishonesty that people will remember. While the House will shortly divide along party lines, the community will not divide along party lines. Many members and supporters of the Australian Labor Party have relied on the hospital services that this Government is destroying.

[Interruption]

When Opposition members interjected during the Minister's response they were called to order and were silenced. I trust that the same courtesy will be extended to me in the few minutes that remain. I thank honourable members who just interjected. They reminded me that it was the Opposition when in office that rebuilt the public hospital system which the former Labor Government had brought to its knees. It was the Opposition when in office that invested $2 billion in rebuilding the public hospital system - Liverpool, Nepean, Maitland, Gosford and Wyong hospitals and the New Children's Hospital, to name but a few. It would not matter whether the Carr Government - to the great misfortune of this State - remained in office for another 20 years, it would never match the Opposition's record in rebuilding the public hospital system, the system it now seeks to bring to its knees.

I acknowledge the support of the honourable member for Manly and the honourable member for Bligh on behalf of their communities. The House will shortly divide along party lines, and although the Minister may escape being condemned by this House, he and the Carr Government stand condemned by the people of New South Wales. They stand condemned by the nurses, doctors, hospital staff, and patients, and by the community in this State. The Minister may be smug and complacent now, but he should take little comfort from the vote on this issue. After 15 years as a member of Parliament, I know that every now and then member's words come back to haunt them. I assure the Minister for Health that this day will return to haunt him during the next three years. This day will be remembered by the people of New South Wales until they get their chance to vote on this motion. When this motion, which will be defeated on party lines, is in effect put to the people of New South Wales in March 1999, it will be carried resoundingly.

I condemn the Minister for Health for his actions. I condemn the absent Premier. He has said nothing in this debate to defend the actions of the Minister, a Minister he was prepared to hang out to dry as a distraction last Friday. The Opposition has no confidence in the Minister for Health. The people of New South Wales should have no confidence in his judgment or in his ability to manage the New South Wales hospital system. After the decision he announced last Friday, nothing is more certain than that the Minister and the Carr Government are running New South Wales health services into the ground. The faster they can be replaced, the better it will be for the people of New South Wales. I condemn the Minister for Health and I ask the House to vote overwhelmingly that it has no confidence in the Minister.

Question - That the motion be agreed to - put.

The House divided.

Mr Armstrong Mr O'Doherty
Mr Beck Mr O'Farrell
Mr Blackmore Mr D. L. Page
Mr Brogden Mr Peacocke
Mr Chappell Mr Phillips
Mrs Chikarovski Mr Photios
Mr Cochran Mr Richardson
Mr Collins Mr Rixon
Mr Debnam Mr Rozzoli
Mr Downy Mr Schultz
Mr Ellis Ms Seaton
Ms Ficarra Mrs Skinner
Mr Hartcher Mr Slack-Smith
Mr Hazzard Mr Small
Mr Humpherson Mr Smith
Dr Kernohan Mr Souris
Mr Kinross Mr Tink
Mr MacCarthy Mr J. H. Turner
Dr Macdonald Mr R. W. Turner
Ms Machin Tellers,
Mr Merton Mr Jeffery
Ms Moore Mr Kerr

Mr Amery Mr Markham
Mr Anderson Mr Martin
Ms Andrews Mr Mills
Mr Aquilina Mr Moss
Mrs Beamer Mr Nagle
Mr Carr Mr Neilly
Mr Clough Ms Nori
Mr Crittenden Mr E. T. Page
Mr Debus Mr Price
Mr Face Dr Refshauge
Mr Gaudry Mr Rogan
Mr Gibson Mr Rumble
Ms Hall Mr Scully
Mr Harrison Mr Shedden
Ms Harrison Mr Stewart
Mr Hunter Mr Sullivan
Mr Iemma Mr Tripodi
Mr Knight Mr Watkins
Mr Knowles Mr Whelan
Mr Langton Mr Woods
Mrs Lo Po' Mr Yeadon
Mr Lynch Tellers,
Mr McBride Mr Beckroge
Mr McManus Mr Thompson

Page 3821

Mr Cruickshank Ms Allan
Mr Fraser Mrs Grusovin
Mr Glachan Ms Meagher

Question so resolved in the negative.

Motion negatived.