Debate resumed from an earlier hour.

Mr GREG APLIN (Albury) [12.02 p.m.]: In speaking to the Health Services Amendment (Local Health Networks) Bill 2010, I note that the shadow Minister for Health has put the Opposition's position very clearly and comprehensively. The shadow Minister indicated that the Opposition will not oppose the bill, but that an amendment will be moved. I note at the outset that the bill amends the Health Services Act 1997 to accommodate Council of Australian Governments reforms agreed in April 2010. In doing so, it abolishes the current eight area health services and establishes a system of geographical local health networks. It also provides for certain statutory health corporations and affiliated health organisations to be constituted and governed on a network basis. I will speak particularly on behalf of the electorate which I represent—Albury—in the southern part of the State, and note that as of 1 July last Albury Wodonga Health came into being. In terms of this bill, our situation is unique. But I do bring to the attention of the House the concerns that have been expressed to me by employees of the Greater Southern Area Health Service and impacts of the bill on local communities.

Currently, national health and hospitals network reforms, combined with New South Wales Government policy to centralise support services within the New South Wales public health system to Newcastle and Sydney will, in my view, have further significant impacts on staff in regional and rural areas of New South Wales. The move to local health networks has increased the pace of centralisation of support services to Sydney. One of the outcomes to flow from the establishment of local health networks was greater participation and involvement of local communities in the operation of their health services. That is something that I support and have advocated on behalf of that merged health service that now exists. However, the ongoing centralisation process placed key decision-making in the area of support services in Newcastle, Sydney and potentially Wollongong. These changes will significantly impact on Albury, with job losses and likely closure of an area office presence since 1974.

In 1974 a regional office was established in Albury, responsible for management of hospitals within the then Murray region of New South Wales. The Murray region covered the area from Tumbarumba to Henty and towns along the Murray from Albury to Wentworth and to the South Australian border. The Murray health region then merged around early 1981 with the Riverina health region to become known as the South West Health Region, and this merger took in the areas around Wagga Wagga.

In 1993 New South Wales split health services further into around 21 district health services across the State. Albury was part of the Hume Health Service, Wagga Wagga was part of the Riverina Health Service, Griffith was part of the Murrumbidgee Health Service and Deniliquin was part of the then Murray Health Service. In 1996 NSW Health formed around 16 area health services with the formation of Greater Murray Area Health, which again took in Tumbarumba and extended to Wagga Wagga, Griffith and Deniliquin, and hospitals in between those towns. In 2005 Greater Southern Area Health Service was formed with the merger of Greater Murray Area Health Service and Southern Area Health Service, and this extended the area further to include Queanbeyan, Goulburn and the South Coast of New South Wales.

In March 2010 the Federal Government announced the establishment of a National Health and Hospitals Network. On 29 September 2010 the New South Wales Government announced the establishment of 18 local health networks under that national initiative with the formation of the Murrumbidgee Local Health Network, incorporating most hospitals that previously were part of the South West Health region of New South Wales during the 1980s.

Since 1974 health services have restructured and realigned staff and services to suit those ever-changing boundaries. A further significant change occurred around 2006 with the formation of Shared Corporate Services, with the centralisation of many support-type services to Parramatta and Newcastle under the banner of Health Support Services. The establishment of Health Support Services by the New South Wales Government has meant that jobs in regional and rural areas across New South Wales have gradually been transferred to Sydney and Newcastle. This has been on an incremental basis.

The following is an example of the impact of those policy initiatives within Albury and other rural areas of the Greater Southern Area Health Service. In 2001 Albury Greater Murray Area Health Service centralised payroll and human resources services to Albury. In 2006-07 Greater Southern continued this process with further consolidation in Albury and Queanbeyan. The changes in payroll resulted in employment of 25 payroll staff in Albury in 2006. In 2007 payroll was transferred to Health Support in Sydney. This resulted in the loss of 20 positions from Albury to Sydney.

In 2009 management of linen services in Wagga Wagga was transferred to Health Support Services Sydney. In 2009 management of Food and Cleaning (Hotel Services Management), previously based across Greater Southern Area Health Service with approximately 700 staff, was transferred to management under Health Support Sydney, with resultant reductions in staff cafeteria arrangements at Wagga Wagga and Albury and proposed closure of the cook-chill production kitchen at Albury. In 2009 the Program of Appliances for Disabled People and Home Oxygen Services transferred to Sydney, with the loss of three jobs. In 2009 management of Procurement and Warehouse Services, based at Wagga Wagga, was transferred to Sydney, with the loss of four jobs. In 2009 accounts payable and sundry debtors invoicing in Wagga Wagga was transferred to Sydney, with the loss of five jobs.

In 2009 pathology services were transferred to Sydney West. This included the public laboratory in Smollet Street, Albury. Recently the Albury Public Pathology Service, which is now part of Sydney West's management, was informed that it had lost the contract to the new Albury Wodonga Health Service, with the imminent downsizing or closure of the public laboratory in Albury likely to affect up to 30 staff. There was no attempt to allow time for the Albury laboratory to reduce its costs so that it could be competitive, and there is a local view that the tender submitted was designed to be non-competitive. The laboratory has been under Health Service Management since 1989, when it transferred to Albury Base Hospital from the Commonwealth.

In October 2010, just a few days ago, 11 Albury staff members were notified that their recruitment jobs in Albury will transfer to Sydney from 1 December this year. These staff will become displaced and these jobs will be lost to Albury. Other services in Albury—such as workers compensation, which has 10 staff, information services, which has five staff, the South West Public Health Unit, which has 20 staff, the medical workforce, which has six staff, human resources support, which has two staff, and staff scheduling, which has five staff—have an uncertain future.

There appears to be undue haste now to have services moved before the next State election. It is likely that within 12 months the significant health presence that has been in Albury since 1974, when the then Murray region was formed, will be lost to Sydney. As support service jobs have disappeared to Sydney, there is now limited to no scope to place staff who become displaced in Albury. It is unlikely that staff will transfer to Sydney, to perhaps lower paid employment, given the loss of their regional and rural connections.

The formation of Albury Wodonga Health has also removed other possible avenues for job placement, with staff not afforded any priority for vacant positions at Albury Wodonga Health. Whilst some jobs may remain within the newly formed local health networks, a significant reduction of support service jobs will be lost to Sydney, further limiting job opportunities for staff wishing to remain. Staff are also concerned that forced redundancies and salary cuts will be implemented by the current State Government. One staff member observed to me that the Health Services Union, which represents many of these staff, has been noticeably silent on the issue of job losses in rural areas such as Albury. The union fully supports the transfer of jobs to what the staff member observes are safe Labor seats, such as Parramatta and Newcastle.

The current strategy of the New South Wales Labor Government appears to be aimed at supporting the member for Parramatta and the member for Newcastle. It is rumoured that further services will be based in Wollongong, for the benefit of the member for Wollongong. Three clinical support centres will be established in New South Wales under the national reform agenda, with Wollongong and other safe Labor-held seats likely to be beneficiaries, according to the staff member. In addition, the Great Southern Area Health Service has set up a transition committee to progress the local health network reforms. The committee established has no Albury representation, and draws its membership from Queanbeyan and Wagga Wagga, with one member from Pambula.

While staff members support efficiency measures, they are not supportive of mass job transfers to Sydney and Newcastle, and this has considerable social consequences on regional areas like Albury. Employees at the Albury office have not seen any evidence that the centralisation of services to Sydney and Newcastle has resulted in any major cost savings or service delivery improvements, as staff are recruited from outside the system in these metropolitan locations. There are significant disadvantages to regional and rural people having to relocate to Sydney. Obviously, addressing these concerns is a matter I intend to take up with the Government because the concerns threaten the Albury community. I will read from a letter received only yesterday from a staff member within the area health service. The staff member wrote:

… the Recruitment Services … with Greater Southern Area Health Service (GSAHS) part of the NSW Department of Health I write to you on behalf of … 11 staff who last week were issued with letters that advised that recruitment services will be centralised through Health Support Services in Parramatta, NSW. Staff were advised that all recruitment processing functions for the Area Health Service will be ceasing as at 6th December 2010 and all 11 staff … face being displaced in our positions. Our Unit currently provides an excellent customer service to all 57 hospitals across the GSAHS, a service where country people are looking after country people. As already demonstrated by the transition of payroll services to Parramatta, when services are managed in the cities those staff don't have the concept of rural life, distance and geographical locations or understand the need to be able to provide support and service to remote regional hospitals in an efficient timeframe. We believe if these services aren't provided in a timely manner then they may jeopardise hospitals in remote areas from functioning to their full capacity.

I ask what is being undertaken to secure positions for rural people in regional areas? Last week (20 October 2010) a media release for $27.6 million for Rural and Regional Hospitals was announced by Federal Minister for Health and Ageing, Nicola Roxon and NSW Minister for Health Carmel Tebbutt stating that they are committed to strengthening health services in regional communities. I realise this funding is targeted towards equipment and beds for rural communities however it does not appear to be ensuring support staff are still retained in rural communities. At this time there are now 30 displaced Pathology Staff, 11 soon to be displaced Recruitment Staff and with the introduction of the new Local Health Networks the likelihood of an additional 80 jobs within the functions of Workers Compensation, OH&S & Risk, IT, Population Health and Asset Management units all likely to be affected in this restructure.

As at 1st January 2011, the Local Health Networks will be implemented comprising three Clinical Support frameworks, where does this leave the 80 staff still working at the Albury Area Office? Strong rumours indicate that these jobs could be transferred to key Labor seats within Sydney—Parramatta, Newcastle and Wollongong.

The Government is continuing to encourage people to make a lifestyle change and relocate to regional rural communities. Saturday's Border Mail emphasised this in its push to boost the population of major regional centres and pushing for businesses and organisations to go rural to assist with population growth.

…

We are very concerned about the proposed centralising of services into Sydney as this impacts not only on our positions here with the Area Health Service and New South Wales Department of Health but … on all facets of the community and regional NSW.

Once again, as happened with the Murray-Darling Basin Plan, the socioeconomic aspects of these moves have been neglected in the push to centralise under the current framework.

Mr ANTHONY ROBERTS (Lane Cove) [12.16 p.m.]: It is wonderful to see the Acting-Speaker [Mr Wayne Merton] in the House today. I support the Health Services Amendment (Local Health Networks) Bill 2010, together with the amendments moved by the member for North Shore, consistent with the long-held beliefs of the Opposition that local health networks provide the best framework for the delivery of health services in New South Wales. In April 2010 the then Prime Minister, Kevin Rudd, followed a long Labor tradition of stealing Coalition policy and selling it as his own. He announced health reforms that mirrored those released by the New South Wales Coalition a year before.

Under the New South Wales Liberal and Nationals policy, released in March 2009, the New South Wales Opposition called for the abolition of the eight area health services—which, by all measures, have now become a bureaucratic flop—in favour of the establishment of 20 distinct health districts, each overseen by local boards drawing upon those with the skills and attributes necessary to make our hospitals work. As can be imagined, without a thought towards the policy's merits, the Keneally Labor Government unleashed its usual barrage of attacks on the Opposition's policy. These attacks came from both the former Minister for Health, the Hon. John Della Bosca, and the current Minister for Health, the Hon. Carmel Tebbutt.

Of course, these attacks stopped abruptly when that former saint-like figure from the Labor Party, Kevin Rudd, decided for the party that perhaps things should be done differently—that perhaps, as per tradition, the Labor Party should take the Liberal-Nationals policy instead and take it national. So, we now have before the House today a bill to establish 18 local health networks—close to the Coalition's policy of 20. It would seem that Labor is so self-assured of its product that it can only haggle us down two and change the name from health districts to local health networks. Well, congratulations to the Labor Party spin-sters, but the New South Wales public is perhaps better educated about the Government's ways than it might think.

However, as with all bills proposed by the Labor Party, there are many failings in this bill. One of the problems that will stem from the bill is its implementation given the haste with which the Government is trying to introduce and develop these structures. Further, there has been very poor consultation with local health officials as to the boundaries of these networks. Whilst the Minister has harped on about "broad consultation" between NSW Health and local doctors, the reality is that this consultation amounted to nothing more than a briefing from head office about what was to be done, as the member for North Shore stated earlier. Additionally, the local health network boundaries were established prior to the Commonwealth establishing the boundaries of the primary healthcare organisations—otherwise known as Medicare Locals. For these Commonwealth reforms to work, local health networks will be required to work very closely with primary healthcare organisations to deliver the best levels of service to patients.

To draw up our boundaries before these ones are known seems like a hell of a gamble to take with our health service. This was pointed out by the State Government's own discussion paper on this matter, which noted that patient care could be fragmented by the separation of hospital- and community-based healthcare. Finally, these changes have not made any real changes to the actual structure of NSW Health. These changes still provide for a head office dictatorship over health services that mirrors in every way the current dictatorship of Sussex Street over Macquarie Street. For example, the Government closed nominations for the chairs of governing councils before it had even announced the boundaries of local health networks. The deadline set for an expression of interest was closed before the legislation was even introduced into Parliament.

It is not even known if the chief executives responsible for the day-to-day running of a local health network will be decided by the chair or by head office. This lack of clarity will continue to support a stagnated bureaucracy in NSW Health when, for once, we have a real chance to get something done and a real chance for reform. Nonetheless, as with every time this Keneally Labor Government introduces a shadow of a Coalition policy, the Government is taking at least a baby step in the right direction. I support the amendment foreshadowed by the shadow Minister for Health and hope that the Government also will support it. I commend the bill to the House.

Mr CRAIG BAUMANN (Port Stephens) [12.20 p.m.]: I speak on the Health Services Amendment (Local Health Networks) Bill 2010. I note these reforms aim to abolish the eight area health services and to establish a system of geographical local health networks. It also provides for certain statutory health corporations and affiliated health organisations to be constituted and governed on a network basis. The bill would also see the establishment of 18 local health networks, comprising eight geographically based local health networks covering the Sydney metropolitan region, seven in rural and regional areas, and three speciality networks. Essentially, I would support any bill and any reforms to the health system that will reap benefits for the people of Port Stephens who have largely been ignored by this State Government, particularly when it comes to health services.

Sure, we are getting a new ambulance station in Nelson Bay, but it is two years late and we are still counting. We have been promised a HealthOne clinic at Raymond Terrace, but that was promised back in 2007 and has already been pushed back until 2012. But worst of all is the Government's neglect of the desperately struggling Tomaree Community Hospital. More than perhaps any other health service in the Hunter, that hospital has been utterly ignored by the equally incompetent successive Carr, Iemma, Rees and Keneally Labor governments.

This Labor Government obviously thought that simply changing the name of the Nelson Bay Polyclinic to Tomaree Community Hospital would instantly make it a hospital in the eyes of the community. It did not. This so-called hospital serves a population of more than 25,000 people; a figure that swells to more than 75,000 in the peak summer period. Yet this so-called hospital that not even have an X-ray machine. Tomaree Community Hospital has been starved of resources and funding under this Labor Government for far too long. The Government continues to stand back and claim services at the hospital are "adequate". Last year the Minister for the Hunter told this House:

I assure all members that adequate services are being provided to the communities of the Tomaree Peninsula.

That was said by a Minister who, as far as I am aware, has never stepped foot inside the hospital. In fact, I would be very interested to know the last time any Minister from this Government has stepped foot inside Tomaree Community Hospital. It is amazing that the Minister could claim services at the hospital are adequate, when the hospital is spending more than $2,000 a day in ambulance costs transferring patients away from it for treatment. In answer to a question I asked last year, the Minister for Health admitted that her Government is spending $808,810 per annum transferring patients away from Tomaree Community Hospital to either Maitland Hospital or John Hunter Hospital, or even down the road for an X-ray, at a cost of around $2,000 per day. That does not sound like a hospital with adequate services. Anything that takes the management of this hospital away from this Labor Government should be a good thing.

The centre of the New South Wales Liberal-Nationals Coalition core ideology is to put the power back in the hands of the people. This State Government has taken all the decision-making from society and put it in the hands of a few Labor hacks. Hopefully, this bill will give the people of Port Stephens more of a say in how their hospital is run. Perhaps then, we can reopen negotiations with the local general practitioners in the Tomaree region who are willing to contribute to a reasonable roster at the hospital, but who have been completely shut out by this State Government.

I turn now to concerns about the bill. As with so many ideas that come from this Government and its Federal counterpart, this bill has come about with great speed and little thought. We all know Kevin Rudd was perhaps the greatest at this, and this is essentially his proposal. If the Building the Education Revolution program and the insulation scheme have taught us anything, it is that our State and Federal Labor governments are good at making grand announcements, but monumentally bad at delivering on them. This bill, like so many others introduced by this Government, has been developed hastily and with minimal consultation. We on this side of the House also hold concerns about the boundaries of some of the health networks.

According to the Minister for Health, the National Health and Hospitals Network Agreement, signed off by the Council of Australian Governments on 20 April 2010, with the exception of Western Australia, will provide a more secure funding base for Australia's healthcare system into the future. According to the Minister, the Commonwealth will provide the majority of funding for public hospital services. The funding arrangements will differ according to the size and location of the hospital. The Minister has stated that small regional and rural public hospitals that have community-service obligations recognised by the Council of Australian Governments, will be block funded, reflecting the higher costs associated with delivering services in those areas. This must result in greater funding for Tomaree Community Hospital, which needs X-ray services and greater support for local services. I want a guarantee that Tomaree Community Hospital will not only remain open under the new reforms but will also be improved to the point that a quarter of the budget is not spent transferring patients to other hospitals for care.

Mr JOHN WILLIAMS (Murray-Darling) [12.25 p.m.]: I will speak briefly to the Health Services Amendment (Local Health Networks) Bill 2010. What we are seeing here is a process that has been gone through at great haste. Within the communities of the electorate of Murray-Darling and its local government areas a lot of questions are being asked about what this bill will mean to them and how it will work. Within a consultative arrangement all key stakeholders should be given the opportunity to understand how this will work in their area. They should know what is proposed, the sorts of effects caused by it, and whether consideration will be given to their views on how it will affect their area.

Whilst I believe this proposed network has given recognition to the Far West of New South Wales, within the scope of the proposed network no consideration has been given to cross-border arrangements. This Government always talks about health organisations taking initiatives and when they do take initiatives they should be recognised. But those initiatives should be recognised within the consultancy for establishing a local health network. I refer to a proposal that has been put together for a primary health care organisation that crosses State borders: the Broken Hill Centre for Remote Health in Far West New South Wales and the Northern Mallee Primary Care Partnership in Far North West Victoria, neighbours divided by State boundaries, that share many relevant synergies, including remote rural isolation, patient-consumer flows, indigenous populations and services, tertiary universities, sporting and cultural ties, and large distance from major cities.

This model was developed after many hours of preliminary consultation at a regional level, fits with Medicare's local objectives, and will deliver under the National Health Care Reform Agenda. It creates a perfect synergy for our local network. I believe sufficient recognition has not been given to the establishment of such a primary healthcare organisation. It should have been recognised somewhere under the local health network that extending the current Far West network was a probability worth considering. It should also have been recognised that we have a transition of health from Far West New South Wales into that north-western area of Victoria. Many people seek health services in Victoria, particularly the community of Wentworth, which has been taken into the Murray network. This is not a suitable arrangement for the establishment of that network. When one looks at the size of the Murray network and the patient flows it is easy to identify that it is not a suitable arrangement.

The proposal is that the areas of Broken Hill, Central Darling, Mildura, Wentworth and Balranald, the unincorporated Far West of New South Wales and the township of Robinvale will make up the geographic boundaries of these primary healthcare organisations. There is already a recognised agreement. The arrangements to set up these networks, which were delivered by then Prime Minister Kevin Rudd, were done on the run. Kevin Rudd said that we should look at what currently works in these areas and the initiatives people have taken to set up a framework that truly reflects the suitability of services in those areas. Under the heading of "Discussion" in a paper provided by the Government there are some interesting facts. It states:

The remote regions in a given state are usually very distant from the major population centres in that state, with service and cultural links often crossing state and territory borders. These regions are not served well by the current state based models that have poorly developed responses to cross border flows.

I believe this will continue under the proposed arrangements. This is not the way Kevin Rudd described it when he first spoke about introducing health reform. He spoke about cross-border arrangements. I do not see the proposal working in any part of the Murray-Darling electorate. People in the Riverina area in particular rely on accessing health care in Victoria. That fact has not been recognised. The department has taken the opportunity to highlight on a map what it thinks is suitable.

In the Government's haste to pass this legislation and meet the deadlines proposed by the Federal Government to enact legislation it has overlooked the very important fact that people in these regional areas have a good understanding of these issues. Consultation would provide an excellent resource and an opportunity to develop an effective network. However, to date we have seen the non-alignment of past health service arrangements with these networks. They are not aligned to the health providers and do not take into account the way that health services are accessed in these areas. The legislation before the House is flawed. We have reached a situation where a system will be put in place without the cooperation of all the key stakeholders. Their input is totally and utterly necessary if the Government is to defend its decision on the arrangement of these networks. A number of services are misaligned by this decision. What we lock in today—regardless of the idea that we can tease out the edges—will be difficult to change.

The period for consultation with or comment by key stakeholders on the proposed network arrangement was insufficient. There is clear evidence that due recognition was not given to the contribution of these organisations. Shortly after the announcement of these networks we saw advertisements for positions on the health councils. It had not even been established that the network arrangements would be adopted. I believe changes would have been made through consultation. There is potential resistance to the Murray network. When these network arrangements were released I advised the shire representatives to comment and contribute. I do not know how many responded but today they are asking questions. They do not believe this system will work for their shire areas. The arrangement does not recognise where people access health services that are not provided by their local hospital or multipurpose service.

For example, Balranald will move most of its patients back into Swan Hill and Wentworth will draw to Mildura. Places such as Deniliquin will draw down to Moama and Tocumwal and Barooga will draw back to Cobram. We have had cross-border arrangements in the past. As I have said, it is a clear indication that this Government is happy to transfer its health responsibilities to Victoria. There should be some recognition of that. If it is to be done in that way, let us form these networks as prescribed by Kevin Rudd. He was dreaming when he made the statement that these networks would work across borders. I do not believe that will ever happen so long as the States manage health. We are already seeing a resistance in cross-border hospitals that New South Wales relies on for services. People from New South Wales are being put to the end of the queue, purely because the cross-border State has a big enough responsibility providing services to its own constituents. This has to be a work in progress. I have no doubt that there will be a backlash against this legislation. I hope in time we draw on those comments and revisit these network boundaries. In my area major issues need to be addressed, but consultation has never been entered into.

Mr JONATHAN O'DEA (Davidson) [12.38 p.m.]: The New South Wales Liberals and Nationals believe that if you trust people they will make good decisions for themselves and others. Honesty is about not fearing accountability. Governments that measure their performance openly and are honest with people about challenges will do better. The New South Wales Liberals and Nationals believe that decisions are best made by the people who are affected and as close as possible to where they will have an impact. That is the driving rationale for the Liberals and Nationals advocating to increase community involvement in the running of the New South Wales public health system.

The Liberals and Nationals have faith in local communities and believe they should be involved in making the decisions that affect their area and their future. The shadow Minister for Health has outlined how, in government, the Liberals and Nationals will empower local communities—by giving them better information and genuine data about local health services and letting them have a real say in the public health system, which is there, after all, to serve members of the public. As detailed in the Coalition's Making It Work health policy released in March 2009, we promised to:

replace Labor's huge and out-of-date Area Health Services with smaller Health Districts; appoint Boards to the health Districts and make them accountable to the communities they serve; restore the decision-making power of Hospital General Managers and give authority back to expert clinicians; further develop clinical networks that link medical experts across the system; appoint a qualified medical practitioner as Executive Clinical Director in each Health District; and publish information about health service management including Budget allocations, the capacity of an institution to undertake treatments and patient care outcomes, through an independent Information Bureau.

Despite Labor's inappropriate criticism of this excellent policy, it is at least pleasing to see that there is now consensus between most health stakeholders, including the Federal Government, that the New South Wales health system needs a flatter and more locally focused management structure that better utilises the expertise of medical practitioners, nurses, other healthcare professionals and the community. I commend the shadow Minister for Health for her leadership, which the Garling report effectively endorsed, and which Federal, and now State, Labor have followed. However, the foreshadowed changes under this bill still require competent implementation, and we have seen repeatedly that Labor is not capable of that at either the State or the Federal level, particularly with public transport projects and building education infrastructure. I fear now that we will also see that incompetence increasingly with health reform. Only a Liberal and Nationals Government will restore confidence in the public health system, properly re-engaging medical practitioners and, once again, giving local communities a strong and direct voice in local patient care.

The Keneally Labor Government is again rushing through a reform for political purposes, despite there still being important unanswered questions. For example, how will staff arrangements work in practice and how will the networks link with primary healthcare organisations when those bodies and their boundaries have not yet been decided? This haphazard and hasty approach helps to explain why local communities and front-line health professionals were not genuinely consulted about the setting of relevant boundaries for the proposed local hospital networks, and why the Government closed nominations for council chairs before the boundaries had been finalised.

I remember that there was similar confusion in 2004 when this same Labor Government, under then Minister for Health Iemma, reduced the number of governing area health service networks from 17 to 8. At that time the Government used some of the same rationale as it is now using to increase the number from 8 to 18. We have gone from 17 to 8 back to 18. This Government fails to recognise that it made a mistake. Certainly, through a number of contacts that I have had and I continue to have, despite now not being involved in the health system, I know that there is widespread disdain for the way this Government has mismanaged the governance of health in this State.

Health infrastructure and service delivery have been mismanaged by Labor for more than 15 years and, despite its words, little is likely to substantially change under this current Labor Government's ingrained culture. In fact, a cynic might even question Labor's real commitment to local health networks and the agreed Council of Australian Governments health reform when Premier Keneally's Government has so recently and dishonourably reneged on its signed agreement over occupational health and safety. We have seen how this has prompted strong criticism from many quarters, including Prime Minister Gillard, who clearly shares the public's growing disdain for this incompetent Keneally Labor Government's mismanagement of many aspects of service delivery within New South Wales.

Ms PRU GOWARD (Goulburn) [12.45 p.m.]: Like many members of the Opposition I do not oppose the Health Services Amendment Bill 2010 but wish to make some comments about the impact that we trust these changes will have on the delivery of health services, particularly in regional New South Wales but across the State as a whole. This comes after 15 years of increasing struggle within our public hospital system and years of criticism from the Opposition about the very large networks that the State Labor Government created and the bureaucracies that appeared to come with them.

As the Parliament well knows, it has been our policy for some time to devolve public hospital administration. In that sense this policy is very much in line with our own thinking and we welcome it. There are, of course, some distinct differences, which I am sure the House has already been apprised of by the shadow Minister for Health. We wait to learn other things, such as how these new networks will link with primary healthcare organisations when those bodies and their boundaries have not yet been decided. That is an important issue for this Parliament and for each member and I trust that as soon as that becomes known and decided by the Government it will advise members.

There are two hospitals in my electorate of Goulburn. One is Bowral Public Hospital, which will now be included in the South Western Sydney local health network that includes Fairfield, Liverpool, Braeside, Bankstown-Lidcombe, Camden and Campbelltown. I welcome that as an improvement on Bowral's existing inclusion in an enormous health network that included Prince Alfred Hospital as well as Liverpool and Campbelltown hospitals. In that sense Bowral was the smallest of those hospitals and very much a younger sister or brother.

It is very welcome that we will now be part of a smaller network. It is not clear to me whether this means that there will be a greater integration of specialist services within the hospitals that make up this new network or how that will address the particular problem we have with renal dialysis patients, who at this stage are required to travel to Campbelltown or Liverpool hospitals for dialysis, despite the fact that three chairs were donated by the community to Bowral hospital, because patients do not have access to a nurse to assist people. I would have thought that sending patients to Campbelltown or Liverpool would be a lot more expensive than paying for an additional nurse.

There is no point in dividing hospital networks into smaller areas if it does not improve the employment of local knowledge and local networks or provide face-to-face discussions between health officials, including doctors and nurses, which mean that the medical resources of a health area network are more effectively used. I would have thought that that is the whole point of making the networks smaller—so that communities are brought together, the network is not so unmanageable because of its size and so that there is an opportunity for local people to make a local contribution and be part of the decision-making in a very direct way, which was just not possible, for example, in the greater South Western Sydney area health network as it is today for a hospital such as Bowral hospital—the only hospital in the entire network that we call a local community hospital.

Ever since I became the local member the hospital's maternity services have been under threat because it has been difficult to retain the services of gynaecologists. The hospital's operating theatres are so inadequate and rundown that wider beds will not go easily through the doors and there is no room for specialist equipment. As a result, we have increasingly lost access to specialist surgery, particularly orthopaedic and eye surgery. Very good local specialists are now doing operations elsewhere, which has meant that local people have had to travel far from home despite the fact that the medical staff are available in Bowral.

Emergency services are increasingly under threat and for some time we did not have a permanent head of emergency at the hospital. I am very pleased to see that that situation has been recently remedied. Bowral hospital is so overwhelmed and underfunded that it is not always possible to get the administration right. An elderly gentleman was recently delivered to the hospital from Yerrinbool, which was 20 cold and windy kilometres from Bowral on the night in question. He walked into the hospital in his pyjamas and dressing grown as directed and was told that his surgery had been cancelled. The staff did apologise that they had not called to advise him before he travelled to Bowral. He had no way to get home other than to walk in the dark, which he proceeded to do. Fortunately, someone saw him walking along the road in his dressing gown and perhaps thought that he was lost and picked him up and drove him home. I do not blame the staff for that; that is what happens when hospitals are overwhelmed and overloaded. Hopefully, this reform package will assist in a case such as that.

Not much has been said to date about exactly how this legislation will improve the efficiency of our hospitals. In theory at least, once we start to make these areas smaller they should be able to deliver real decisions made by local people who know what they are talking about and what is needed. Goulburn Base Hospital is a very old and wonderful facility that has very big operating theatres. It has recently received money for an upgrade and we are all very grateful for that. However, I am disappointed that I learnt about it only by reading the newspaper. It would have been courteous of the Government to advise me by letter. However, we are very pleased to see that the hospital has been provided with that money. I only wish that Bowral hospital could attract similar funding.

The children's ward at Bowral hospital was appallingly rundown. It was all mixed up with the day surgery unit and the renal unit and children could not be observed from outside their room. In fact, the ward had none of the facilities one would expect to see in a modern paediatric ward. That has been addressed, but only because the local community raised $500,000 and shamed the Government into doing something. On the day the refurbished facility was opened a senior health official said to me, "We know that one day, fairly soon, this hospital has to be knocked down. This project was the only way we could shut up the community." There is another way to shut up the community; that is, to make sensible decisions and to recognise that although Bowral hospital might be only a community hospital in the eyes of the bureaucracy its importance to a very rapidly growing and ageing community cannot be underestimated. It was unfortunate that Bowral hospital was always at the bottom of the list because it was competing for attention with facilities such as Liverpool Hospital and Royal Prince Alfred Hospital.

I have no doubt that once this new system is properly established it will produce very welcome improvements. However, while Goulburn Base Hospital functions very well, it is absolutely horrifying to see that the new region still stretches right down to Batemans Bay. The hospital is in a health region that includes Batemans Bay, Bega, Bombala, Braidwood, Cooma, Crookwell, Delegate, Moruya, Pambula, Queanbeyan and Yass. That is an enormous area and I predict that there will still be inefficiencies in administering it unless the staff are very smart with e-communications and do a lot more video conferencing. I have seen many health officials visiting Goulburn Base Hospital who have travelled almost from the Victorian border in a day for a meeting. That must change.

I suspect that the region is still too big and I urge the Government to examine it and to consider subdividing it as a matter of urgency. It is all very well for the Government to say that it needs evidence and that it will suck it and see, but we can be confident that it will be very difficult to manage a health region bigger than Wales or Scotland. Why take the risk? We have had enough change and every change takes a while to bed down. We should go straight to the right answer, which is to subdivide the southern local area health network.

Mrs DAWN FARDELL (Dubbo) [12.57 p.m.]: I support the Health Service Amendment (Local Health Networks) Bill 2010. My constituents believe that insufficient time was allowed for submissions on the legislation to be lodged. I commend looking at structure and change to meet current and future needs. The new area health network incorporating Dubbo is about the size of Germany, which is a huge area to administer. I will refer to part of my submission expressing the community's concerns about this legislation. The primary concern has been the boundaries of the proposed network incorporating the electorate of Dubbo. My submission is based on not only my observations but also wide-ranging discussions I have had with regional councils, clinicians, non-government organisations and the everyday men and women of my electorate who have shared their experiences of the local health system. I am also indebted to the Orana Regional Organisation of Councils [OROC], which incidentally has a meeting at 4.00 p.m. today with the staff of the Minister for Health about this legislation.

At the outset I register my concern about the haste with which the new boundaries of the local health networks were defined in New South Wales while the Commonwealth was undertaking its own submission process. Furthermore, with the New South Wales election only six months away, it is entirely conceivable that there will be a marked change in the political landscape that could directly impact on the administration of health services and facilities throughout the State. It was pleasing to hear the member for Goulburn say that the Opposition will not oppose this legislation. However, a more open discussion of the potential network boundaries within the broader context of the agreement would have been a more helpful exercise for health providers and consumers and it would have assisted incoming Federal and State governments with useful feedback for progressing health reform.

I addressed three issues in my submission about the proposed networks: first, greater flexibility for rural and regional communities; secondly, recognition of the natural communities as a key determinant; and, thirdly, key indicators in network delivery of patient care. The Central West model did not fulfil the national health and hospitals networks stated goals. The following points relate to how these goals have been interpreted and applied to the New South Wales discussion paper.

In regard to the greater flexibility for rural and regional communities, the discussion paper made a number of impressive claims regarding the overhaul of health care across the nation, including a fundamental shift in the way health care is delivered to make it easier for patients to navigate and access services in their community. The plan also proposed that the eight existing New South Wales area health services would be replaced by 17 local health networks, more than doubling the number the health divisions in New South Wales. That is a positive move and, on the surface at least, would appear to provide more local and responsive health delivery.

Unfortunately, despite those lofty intentions, the proposed western local health network demonstrates no strategic vision or flexibility that might deliver improved health outcomes for rural communities in the State's west. The model as proposed incorporates the regional cities of Dubbo, Orange and Bathurst. It also includes about 40 communities and covers more than one-quarter of New South Wales. The Central West model largely duplicates the current and unwieldy Greater Western Area Health Service with the exception of Broken Hill, which has been removed because it is closely aligned to South Australia, and we all accept that.

Submissions lodged by the Orana Regional Organisation of Councils and Dubbo City Council clearly detailed the stress, uncertainty and the financial deprivation suffered by those who are forced to travel hundreds of kilometres from their homes and familiar social networks to access health care. That is particularly so in the case of cancer treatment, which is very limited in Dubbo. Persisting with cobbling together dissimilar communities over vast stretches with few transport options with the overwhelming majority of health service concentrated towards the eastern border of the patient catchment will continue to disenfranchise rural and regional communities and restrict access to appropriate and timely health care. It is also evident that the western model does not embrace strategic vision for future health care delivery. It is essentially more of the same and is based on discredited assumptions about the way country people and rural and remote communities access health services. As for the recognition, "natural communities" is a key determinate.

The city of Dubbo is a vital service hub that provides health, education, financial, business, government and non-government organisation services to all the communities of the State's west. There is a strong economic interdependence between this regional city and the smaller communities to the west. Each year more babies are born in Dubbo—approximately 1,300—than Orange and Bathurst combined, and more than half of these mothers come from communities outside Dubbo. Some months ago I formed a committee. I chaired the first two meetings but I have now stood aside to remove the politics. That committee is now chaired by the Dubbo Health Council and seeks to provide accommodation for out-of-town mothers. It is hoped that people attending for operations will be able to utilise the facilities. Lourdes Hospital has a proposal to provide temporary accommodation for a couple of years until Dubbo Base Hospital has the necessary facilities. With the support of surrounding communities, the city is currently investigating the establishment of accommodation for out-of-town mothers and I thank the Dubbo Health Council for taking that matter on board.

A trip to Dubbo usually serves a number of purposes, such as attending medical appointments, banking, accessing government services, pursuing educational opportunities, shopping, social activities and visiting family. A recent regional health survey by the Orana Regional Organisation of Councils of 2007 found that 70 per cent of respondents identified Dubbo as their preferred location for accessing health services while only 10 per cent preferred Orange. The angst by Orana Regional Organisation of Councils and Dubbo residents referred to the delivery of different services to Orange and Bathurst and was why the feeling at the time was for a separate local health network.

The submissions by Orana Regional Organisation of Councils and Dubbo City Council, which the Minister has seen, called for the local health network to be based in Dubbo. This would meet the natural communities test and support the particular challenges of rural medicine, including the demands of indigenous health, maternity and aged care. We are aware that, for varied reasons, many people in Aboriginal communities do not fill in the census form so the Australian Bureau of Statistics figures may not be accurate as to the number of people accessing services, not only health services but also other services in Dubbo. Both Orana Regional Organisation of Councils and Dubbo City Council suggested potential boundaries for a separate local health network to make it more responsive to the health service needs of communities west and north of Dubbo.

I met with the Minister and I appreciate the time that she and her staff have given me. I have made numerous phone calls, to which they have always responded, explaining why Dubbo needs to be included in the same network as Orange and Bathurst. That is not merely my opinion; I have sought the opinion of medical professionals. The surgeons at Dubbo Base Hospital and members of the Dubbo Plains Division of General Practitioners have also spoken to me. Considerable time and effort has been expended by the Chief Executive Officer of the Greater Western Area Health Services, Danny O'Connor, who has the confidence of the community. Doctors working out of Orange, servicing Bathurst and Dubbo, are on one contract.

If another health service were involved, it would require two separate contracts but many things could prevent that from happening. Visiting medical officers are happy to work under the network. I was originally annoyed—and some members of Orana Regional Organisation of Councils are still not convinced—but I am now convinced. No deals have been done; common sense has prevailed and I have listened to the opinions of the medical professionals upon whom we rely to come to our community. It is very difficult to attract medical professionals, which is why maternity services are now located in Dubbo. General practitioners no longer deliver babies outside the Dubbo area, so that women from other areas now find it difficult to deliver their babies locally. Although it is a very large network, I am confident from speaking to the professionals about the contracts that the system will work. It is also important to ensure that the right people from a cross-section of the communities represented by the western network are on the governing councils. This is only a line in the sand. We merely ask that good health services are delivered to the electorate of Dubbo and the Far West.

Mr THOMAS GEORGE (Lismore) [1.07 p.m.]: I speak on the Health Services Amendment (Local Health Networks) Bill 2010. In April 2010 the State entered into the National Health and Hospitals Network Agreement with the Commonwealth, certain other States and Territories. The objects of this bill are to amend the Health Services Act 1997, firstly, to establish a system of local health networks for the purposes of the National Health and Hospitals Network Agreement for the whole of the State; secondly, to provide for certain statutory health corporations to be constituted and governed on a network basis so as to enable them to be recognised as health networks for the purposes of the National Health and Hospitals Network Agreement; thirdly, to enable certain affiliated health organisations to be recognised as networks for the purposes of funding under the National Health and Hospitals Network Agreement; fourthly, to make other related amendments in the nature of statute law revision; and, fifthly, to enact provisions of a savings or transitional nature and to make consequential amendments to certain other Acts and statutory rules.

Earlier today the shadow Minister and member for North Shore clearly identified the Opposition's concerns, and every member has views and needs in our electorates relating to health issues. The Government criticised the Opposition's policy on district health boards that it took to the last election. Even the Chief Executive Officer of the North Coast Area Health Service, Chris Crawford, was critical of the district health boards. However, now the Government has virtually reinforced our policy, although there may be some dispute about the number of district health boards.

Concern has been expressed about the haste with which the Government has developed the new structures. There has been poor consultation, inappropriate boundaries and there do not seem to be any links with primary health care organisations. Questions remain unanswered with respect to the governing councils and the role of the health head office. We value the comments of doctors and health administrators, but the bill seems to be missing some detail. I note that the Health Services Association has been successful in ensuring that the legislation allows the Minister to deem affiliated health organisations not-for-profit bodies such as Tresillian, Hammond Health, Catholic Health Care and Calvery Health Care as health networks. These organisations are concerned that, while any area health service can make application to become a health network, the bill omits the criteria on which an area health organisation is to make an application.

This Labor Government said everything would change on 1 July as a consequence of the Council of Australian Governments health agreement, but to date nothing has changed. Hospitals are still struggling and patients are waiting too long for treatment. Case after case has been mentioned this morning. Those in the Northern Rivers are no different. I instance Lismore Base Hospital, which has been the subject of headlines such as "Sickening Wait" and "Bed shortages at Lismore hospital causes ambulance backlog". That was not a staged backlog. A reporter rang me and said, "I'm just driving past the hospital; I cannot believe it, but there are five ambulances there." That has created concerns. That is happening day in and day out. It is not an everyday occurrence, but it is happening all too often.

The member for Goulburn spoke about patients being released from hospital without being provided with appropriate support to enable them to return to their residence or wherever. Recently, I highlighted concern about a 70-year-old patient who was admitted to intensive care at a hospital in Lismore. When his wife came to visit him in intensive care, he was told he could go home. Although she did not have a car and they live at Casino, 40 kilometres away, they were marched out of intensive care and told to find their own way home. Another gentleman was admitted to a multipurpose services hospital at Bonalbo with what were thought to be stones in the kidney. He was kept there over the weekend, treated, and even given morphine. He was transported from Bonalbo to Lismore by ambulance to have appropriate scans or tests. At Lismore, he was told, "Sorry, you don't have stones in your kidney." Although he was still in serious pain, he was told, "You'll be able to go home now." He said, "Where's the ambulance?" They said, "He's gone. You'll have to find your own way home." Home was a hundred kilometres away, and he was still in pain and on morphine. Because scans did not show that he had kidney stones, and even though there must have been something else wrong with him, he was told to go home. Every member could tell such stories.

Before the recent opening of the cardiac catheter laboratory at Lismore, public patients with heart concerns were brought by air ambulance to Sydney. There, after it was determined that they did not have a heart problem, they were told, "Thank you, you can go home now." People have rung my office and asked, "How do I get home?" But that is only part of the system. Lismore Base Hospital has an ongoing issue. It is the base hospital of the area. For years the community had been led to believe that stages one and two had to be completed before stage three could be started. Stages one and two have been completed. But over the years stage three has fallen from the plans. We now have bed-locks and bed shortages.

Mr Daryl Maguire: They promised you a new hospital too, did they?

Mr THOMAS GEORGE: Yes. It has been an ongoing promise.

Mr Daryl Maguire: As with Dubbo, Tamworth, Parkes, Forbes and Port Macquarie.

Mr THOMAS GEORGE: Stage three has fallen from every plan available to the community. As the member for Wagga Wagga indicates, most members of this House could speak about hospital problems. Over the years governments have encouraged Lismore to be the base hospital. People have been influenced to send patients to Lismore Base Hospital. That is all right if it has the facilities, but it does not. Public transport is also not available. Further, service cuts in outlying hospital areas have forced people to go to Lismore Base Hospital, which sadly does not have in place the infrastructure necessary to enable the hospital to handle all the problems it should be able to deal with. The one thing that I am quite proud to say is that Lismore does not have a shortage of top specialists, whether in cancer, orthopaedics or whatever. We have sufficient specialists to handle any issue. I pay tribute to St Vincent's Private Hospital in Lismore. It has been an asset that has drawn specialists to the Northern Rivers, especially to Lismore. If St Vincent's Private Hospital did not exist, the facilities at Lismore Base Hospital would not be enough to entice specialists to the Northern Rivers.

I commented earlier about the areas listed in the bill. I ask the Minister to comment in reply on the matter I raise. The bill notes that the Northern New South Wales Local Health Network includes the shires of Ballina, Byron, Clarence Valley, Kyogle, Lismore, Richmond Valley and Tweed. There is a hospital within the network at Urbenville, which is in the Tenterfield shire. It was part of the old Northern Rivers Area Health Service, now the North Coast Area Health Service. Tenterfield is not listed in the program. I would like that matter clarified.

While I am speaking about the Tenterfield shire, I raise a matter that the Speaker, if he were in the chair, would confirm. I do not represent the town of Tenterfield but the Speaker and member for Northern Tablelands does. The Speaker and I made representations to the Minister for Health following representations to us by the council and the community that Tenterfield hospital be included. The Urbenville hospital, in the Tenterfield shire, is in the North Coast Area Health Service, but Tenterfield hospital is not; it is in the Hunter area. Tenterfield people, who automatically come down to Casino or Lismore for all their services, have been trying to have that hospital included in the North Coast Area Health Service, or what was the old Northern Rivers Area Health Service. I ask the Minister—I believe with the support of the Speaker, unless there has been a change in the community since I last spoke to him on the issue—to consider including Tenterfield in the Northern Rivers area. Some comments on that would be appreciated.

Typical of the Keneally Labor Government, it is rushing through reforms without addressing many unanswered questions. Another headline in a local paper amused me. As all members realise, every area health service had an advisory council. Our advisory council advised the Minister that the current service, the North Coast Area Health Service, should be retained. However, Dr Chris Ingall and Dr Peter Rankin, chair of the Lismore Base Hospital Medical Staff Council, soon sent off a letter to inform the Minister that after extensive discussions over the past few months there was "unanimous approval from within the larger doctors group for the breaking up of the present cumbersome North Coast Area Health Service".

This was suggested in the Garling report. Many of the complaints registered this morning have been brought forward in the findings of the Garling report. For example, the finding regarding the exiting of patients from hospitals has not been acted upon appropriately, particularly with regard to hospitals in my electorate. The Government has not acted upon the findings of the Garling report. I strongly believe that the legislation is being rushed through the Parliament. It is typical of the way the Keneally Labor Government handles its legislation.

Mr ROB STOKES (Pittwater) [1.20 p.m.]: The Health Services Amendment (Local Health Networks) Bill 2010 amends the Health Services Act 1997 to accommodate the recent Council of Australian Governments [COAG] health reforms. Previous speakers on this side of the House have already referred to the fact that there is a fair bit of hypocrisy about the bill in relation to the Government's opposition to proposals by the New South Wales Nationals and Liberals to do effectively what the Government's bill seeks to do. It is a bit rich that the Government attacks the Coalition for referring to the need to improve local accountability of the health system, when effectively this bill, which is a response to COAG health reforms, seeks to do exactly that.

We have known for some time that there have been significant problems with overcentralisation and increasing bureaucracy within the health system. New South Wales has a health system that employs almost 100,000 people. An article in the Daily Telegraph of 8 March 2010 referred to the fact that NSW Health's 2007-08 annual report stated NSW Health had almost 95,000 employees and that 72.6 per cent of staff were medical staff, which meant that more than a quarter, or 25,800 staff, were administrators. I suspect there are more health administrators in New South Wales than there are soldiers in the Australian Regular Army. When we reach that situation, clearly things are ridiculous and out of control.

When former Premier Iemma introduced the eight area health services in 2005, there were obviously major concerns—and the Garling report pointed out many of them—that this process set up a system that was significantly overcentralised. The Garling report noted, "It is clear that the establishment of the eight area health services has caused serious disruption and unrest." The Garling report also noted that the restructure "created an over-centralised management structure which has only alienated clinicians who are the heart of the public hospital system". The report also noted that the geographic areas, particularly in regional areas of the State, were "immense", rendering them difficult to organise. It is clear that the area health system approach—

Mr Brad Hazzard: Was a disaster.

Mr ROB STOKES: —was a disaster. It was too overcentralised; it was not responsive to local needs. The establishment of local health networks is critical. It is extremely important to devolve decision-making on issues that are as important as public health and that directly affect local communities and individuals. It is imperative that local health networks be responsible to the local communities they serve. That is why this reform is so important. It is important that the system envisaged by the bill is set up correctly, and it is why the bill needs to be very carefully considered. The system this bill introduces needs to be introduced very carefully.

My mentor in a law firm always used to tell me, "The long way is always the short way." That is similar to a saying I know teachers are fond of, which is: Proper preparation prevents poor performance. It is the same in relation to these systemic changes in the health system. We need to ensure we get this reform right. If we do not do so, an already bloated bureaucracy will simply have another layer of bureaucracy inflicted upon it. That is the danger we face if this reform is not implemented properly. I do not for one moment suggest that this reform is not necessary: it is very important. But it needs to be done extraordinarily carefully, and it needs to involve cultural change in relation to the bureaucrats that are subject to the system. Without cultural change, this may end up making the morass even worse.

In 2009 Wolfgang Kasper, Emeritus Professor of Economics at the University of New South Wales, wrote an excellent report entitled "Radical Surgery: The Only Cure for New South Wales Hospitals", a Centre for Independent Studies policy monograph report. In the report Professor Kasper referred to the new bureaucracy established by the area health services. He wrote:

The new bureaucracy has closed a number of hospital beds, hospital wards, and even entire hospitals. For example, no fewer than 34 maternity units in country NSW have been shut down over the past thirteen years. The tendency has been towards "big is beautiful", irrespective of what the clients may want. The trend has been to cut costs by reducing facilities and services rather than searching for improvements in productivity. This is of course typical of most central bureaucracies: Fewer and more uniform facilities are easier to plan and control, while the pursuit of customer service is seen as an inconvenient nuisance.

I can give a local anecdote to support Professor Kasper's comment. In my community of Pittwater we have seen a central edict that has closed down our local maternity ward, and has seen a 40 per cent drop in the number of public maternity beds available to the more than 230,000 people who live on the northern beaches. The closure of the Mona Vale Hospital maternity ward has seen the centralisation of all services at Manly Hospital. That might be terrific for bureaucrats because it makes it easier for them to plan. It is also easier for them because it has resulted in a significant reduction in the number of women using public hospital facilities for giving birth. In turn, that may tend to make the bureaucrats' statistics look better because there are fewer patients. The Yes Minister example of the perfect hospital for a bureaucrat is a hospital that does not have any patients. While that might work terrifically well from the perspective of a bureaucrat who is not interested in service, it does not serve the health workers, the obstetricians, the midwives, and the local communities that depend on these services.

For example, there are 16 beds in the maternity ward at Mona Vale Hospital and there are 17 beds in the maternity ward at Manly Hospital. We are told by the bureaucracy that we now have a better service which delivers 40 per cent fewer beds. There are only 20 beds in the new "improved" maternity ward at Manly Hospital. There has been a significant reduction in access to services. Ridiculously, under the new model obstetricians who are visiting medical officers at Mona Vale Hospital are now prohibited from providing obstetrics services. Women giving birth at Mona Vale Hospital now have access to midwife-only services, with no intervention allowed by the obstetricians who serve Mona Vale Hospital. If anything goes wrong in a routine pregnancy that turns into a non-routine delivery, what is the response of the bureaucracy? "We will put them in an ambulance and take them to Royal North Shore Hospital." That is not as a solution; it is negligent and dangerous, and it puts the lives of expecting mothers at risk. That is a local example of why we need to get these structural changes right. If we do not do so, we will make the problem even worse.

The problem we face in New South Wales is that front-line hospital services—the number of hospital beds and the health workforce who care for the patients—have been cut back progressively while the hospital administration has grown. I quote further from the Kasper report:

... Many a nurse and doctor have been pushed from patient care and the ward into administration by pay relativities and career opportunities, which make frontline service unattractive.

This reform needs to address those types of problems. If they are not addressed, we will make an already difficult situation worse. While devolution and more local input into local health services is crucial, if it is not done properly we will make a bad situation worse. We were told that the proposal as to the maternity situation at Mona Vale Hospital was endorsed by the Area Clinical Council. As a result of inquiries, I have ascertained that the Area Clinical Council did not involve any of the obstetricians or midwives, or anyone who provides maternity services at Mona Vale Hospital. The people who are making decisions about local health services and local health care do not include representatives from the affected community or the health workers who provide the services in question. These are but some of the issues that need to be considered in this reform. I will say it again: If we do not get this important reform to bring in local accountability and devolution right, we will make a bad situation worse. This reform is vital but I am concerned at the haste with which it has been brought in. We really need to focus on this to get it right.

Pursuant to standing orders business interrupted and set down as an order of the day for a later hour.

[The Acting-Speaker (Mr David Campbell) left the chair at 1.30 p.m. The House resumed at 2.15 p.m.]