The ramping crisis in South Australia cannot continue. We know that there are many strategies for ending ramping in our state, and we must take action with urgency to protect our community and our emergency health workers.
As an important step towards ending ramping, the Greens will introduce and fund urgent care centres in SA. Urgent care centres can play an important role in the health system by servicing low acuity but urgent illnesses and injuries - in other words, looking after patients in the space between primary care and emergency.
By providing an alternative pathway for patients in South Australia, we can reduce the number of ambulance dispatches and emergency department presentations for low acuity cases, reducing the load on emergency departments and hospitals in our state. We already know that 69% of people presenting to South Australian Emergency Departments do not need to be admitted to hospital. Further, in the last year, the SA Ambulance Service transported 61,555 people who required some form of help but didn’t actually need an emergency ambulance response. This is a massive - and avoidable - strain on our emergency health systems.
South Australia currently has four similar centres - referred to as Priority Care Centre - at trial sites across the state, and they have shown great promise. But these centres are still under resourced, only available under specific circumstances, and again only open until 6pm. We will therefore not only establish more (and proper) urgent care centres in South Australia, but ensure they are funded and staffed to operate out of hours and on weekends.
The Greens want to introduce an Activity Based Funding Model for the South Australian Ambulance Service (SAAS), including reinvesting current fee-for transport revenue back into the SAAS. An Activity Based Funding model would enable SAAS to ensure both actual and projected activity is factored into workforce planning, meaning that proper resources and staff are recruited in advance of when they are needed - future-proofing the service.
We will also resource and recruit more paramedics and ambulance officers to ensure that we have adequate staffing across South Australia to respond to emergency health situations appropriately, ensuring that we can keep the emergency crew utilisation rate below 55% so that there are always crews available to respond to incoming emergency cases.
This means recruiting the following numbers of paramedics and ambulance officers across the following areas:
|Service Area||Additional Resources Needed|
|Metropolitan Adelaide||128 paramedics (8 additional crews) and 36 ambulance officers|
|Limestone Coast||1 x 24/7 emergency ambulance crew and 1 x 12-hour additional Regional Medical Transfer Service (RMTS) ambulance crew, both located at Mt Gambier. Additionally 1 RMTS ambulance crew at Keith.|
|Adelaide Hills, Barossa Valley & Fleurieu Peninsula||
1 x 24/7 Emergency Ambulance Crew and 1 x 12-hour RMTS Ambulance Crew, at both Gawler and Mt Barker. 1 x 24/7 Emergency Ambulance Crew at Victor Harbor
|Far North and West Coast||1 x 24/7 Emergency Ambulance Crew at Whyalla and 2 x 12-hour RMTS Ambulance Crews in the region. 1 x RMTS Ambulance Crew at Peterborough|
Community Health Centres
Decades of successive Government failure to invest in community based primary healthcare means our emergency departments are regularly overwhelmed.
The Medicare rebate is far too low for many doctors to provide a bulk-billing service, which means many South Australians miss out on the care they need because they can’t afford it. It’s time that a State Government stepped in. Employing and paying public GPs will ensure that, rather than having to churn through as many patients as possible in a day to earn an income, doctors will actually have the time to follow up with patients and give appointments the time they deserve.
By providing people with ready access to primary health care, we will reduce the pressure on hospitals and ensure that everyone in South Australia has access to universal, free public healthcare.
Establish 68 free public health clinics across SA with publicly funded and salaried GPs, nurses, and allied health professionals including physiotherapists and public dentists
Each clinic on average will be staffed with 10 GPs and 15 nurses in addition to allied health professionals and dental. The public health clinics will be built across SA with the services tailored to communities’ needs. Clinics will be funded to be open seven days a week and out of hours to ensure people aren’t forced to attend an emergency department unnecessarily.
We will also provide scholarships and support to train and retain more doctors and nurses in our public health system, working together with unions, universities, and health practitioners to undertake workforce planning in the public health sector to ensure we always have enough doctors and nurses to meet the needs of our State’s population.
Prevention is Better Than Cure
Why have an ambulance waiting at the bottom of the cliff when you can build a fence at the top?
Primary health care is crucial to the provision of a responsive, effective, and high quality health system. Successive reviews both internationally and in Australia have recommended that governments should reorientate their health systems towards primary and preventative health care. But despite the strong evidence and recommendations, this has not happened. Instead, over successive years South Australian Governments have cut health promotion services and changed the emphasis of primary health services so that they instead focus on intermediate care and ‘hospital avoidance’ strategies, and the detrimental impact of these cuts continues to be felt strongly throughout our community. Instead of community engagement, disease prevention, health promotion and action on the social determinants of health, we’re seeing increased pressure on emergency departments and devastating ramping in our hospitals.
These cuts to primary and preventative health care services are also contrary to Governments’ stated aims of reducing health spending: indeed, we’ve only seen spending increase without an improvement in outcomes. Further, international evidence indicates - as acknowledged in the World Health Report - that “primary health care is not cheap: it requires considerable investment, but it provides better value for money than its alternatives”.
The abolition of the Health Promotion Branch within SA Health represented a concerning downgrade in attention and planning for health promotion, with further capacity for health promotion in our state dented by the withdrawal of support for the Primary Prevention Plan - even though the Plan had wide support and provided an excellent strategic planning framework for disease prevention and health promotion in South Australia. While we now have Wellbeing SA, the scope of their work is far more limited than previous health promotion programs and branches.
Even as far back as 2014 the experts were warning that these cuts would see increased pressure on the hospital system, and that people - particularly facing multiple disadvantages - would not have the local supports or services they need, likely leading to more serious and adverse health outcomes for individuals and higher health costs.
The Greens know that prevention is better than cure. That’s why we want to refocus our health system on primary health care services and preventative health. This is essential to ensuring we have a healthy community, and to reducing the strain on our emergency departments and hospitals.
The Greens will:
|▲||Invest $15 million over four years to establish a dedicated Preventative Health Taskforce|
|▲||Work together with SA Health, other agencies, health advocacy organisations and stakeholders to develop and implement an evidence-based and comprehensive South Australian Preventative Health 2040 Strategy|
|▲||Establish and administer a $5 million Grants scheme for organisations delivering services on the ground in coordination with and evaluated against the South Australian Preventative Health 2040 Strategy|
|▲||Bring back and publicly fund community health centres (see community health centres initiative)|
|▲||Increase funding for the Health Performance Council|
|▲||Reinstate the Obesity Prevention and Lifestyle (OPAL) program|
|▲||Reinstate Aboriginal health workforce initiative|
|▲||Reinstate the Community Foodies program|
|▲||Reinstate the Start Right - Eat Right program to get South Australian kids eating healthy from a young age|
Nursing and Midwifery Ratios
The Greens are strongly committed to ensuring that South Australia not only has public provision of health services, but that these services are adequately resourced and staffed. We are committed to legislating for minimum nursing/midwife to patient ratios, and have been working on drafting this legislation over the past few months. We know that these ratios ensure the safest quality of care for every patient in the state’s public hospital system. The evidence is clear: the number of patients allocated to a nurse or midwife on a shift is directly related to patient safety and mortality, and to the quality of care patients receive. Ratios save lives.
It is a key element of Greens health policy to increase nurse staffing-to-patient ratios and skills mixes that ensure patient safety, better health outcomes, high recruitment retention, continued professional development, and adequate training of staff.
The Greens will introduce legislation that would emulate the Victorian model for legislated minimum nurse/midwife to patient ratios. We know that these ratios ensure the safest quality of care for every patient in the state’s public hospital system.
Free Hospital Parking
Public health should be universal and free, but too many South Australians are forced to pay high fees to both access and provide health care in the form of parking fees. In 2021 alone hospital parking fees rose by 7%, making parking at some public hospitals in Adelaide more expensive than parking in Sydney.
The South Australian Government receives tens of millions of dollars in revenue from parking fees at public hospitals each year, and appallingly about 50% of that revenue comes from SA Health Staff Members.
The Greens will scrap hospital parking fees and make access to public healthcare genuinely free. We already know that this can be done: the South Australian Government has made parking free for health workers during the pandemic. This should continue to be the case after the pandemic, and should be extended to patients as well. Parking is already free at all country hospitals in our state - it’s time we extended that to metropolitan hospitals as well.
The Greens will make hospital parking free in all public hospitals in our state.
Head Start Bundles
The Greens will introduce free baby bundles for new families in South Australia, to ensure that all children in South Australia have a more equitable start to their lives. We will invest $6 million over four years in providing support and necessities to first-time parents in South Australia - including foster and adoptive parents/carers.
All first-time South Australian families will be eligible for a baby bundle, including first-time foster and adoptive parents/carers with babies up to three months old. A baby bundle will be available for each baby, so families with twins will be eligible for two baby bundles, triplets for three and so on.
The contents will include:
- four picture books by South Australian authors
- a nappy bag to hold the products
- a growsuit
- a safe sleeping bag
- cotton wrap
- a teething toy
- a first-aid kit
- a baby sun hat
The baby bundle will include a passport-booklet of useful information designed to assist parents in navigating this time of change and transition with their new baby. It will also include information on sleep and settling, safety, reading and sharing books with your baby, and a list of emergency contacts.
Each bundle also includes a double-sided bookmark with reading ‘tips and tricks’ for families, three ‘This book belongs to…’ stickers and one replica ‘My Library card’, to encourage parents to swap this for a real library card to borrow books with their children at their local library.
Free sport and recreation for South Australian Kids
Every child should have the right to play organised sport, or participate in organised recreation activities, regardless of their parents’ ability to pay.
Registration fees for local sporting and recreation clubs are becoming increasingly unaffordable, with the average national spend per child coming to nearly $800 while some clubs have been charging up to $2,000 to play. Some families are having to rely on payment plans just so that they can afford for their kids to play sport or otherwise participate in their community. As a result, children from low-income families are almost 50% less likely to participate in sport or other recreational activities outside of school hours.
Free club sport and recreation would change hundreds of thousands of children’s lives for the better, saving families thousands of dollars and injecting more money into our local community sports and recreation clubs at a time when they desperately need it.
It would also mean that all kids in our State have better access to a healthy, active lifestyle and allow them to connect with more kids in their community.
The Greens will:
|▲||Guarantee all South Australians under-18 a free season of organised sport or recreation every year by covering all registration costs, paid directly to clubs|
|▲||Provide $10,000 grants to sports and recreation clubs to help upgrade facilities, recover from the impacts of COVID-19 and handle the extra registrations that will come with free sport and recreation|
|▲||Give parents and carers a $150 rebate for the purchase of sports equipment|
Reducing harm from drug and alcohol use
The Greens want to create a safe, healthy and connected community by reducing the harm caused by the stigmatisation and criminalisation of people who use drugs. We believe that drug use is a health issue - not a criminal one.
Despite the popularity of a ‘tough on crime’ approach, a diverse range of people take drugs - especially at music festivals. The harm people experience is typically a result of the stigmatised and criminal approach to people who take drugs. The current approach means that people don’t have access to the information they need to make an informed decision about the risks of pills they have purchased and intend to take. They don’t have access to health professionals that can provide advice regarding what, if any, toxic substances are in the pills they have purchased, and the risks these toxins would pose. Experience around the world has shown that pill testing is the quickest and most effective way of improving people’s understanding of the possible risks of drug use. It also allows different government agencies to understand if there are any toxins in the drugs that people are taking, and ultimately saves lives by supporting the disposal of substances that aren't what people thought they were.
Medically Supervised Injecting Centres (MSICs) are places where people inject or take drugs, such as heroin or methamphetamine (ice), under the supervision of medical staff and health professionals. MSICs are also referred to as drug consumption rooms. But these facilities provide more than overdose prevention. The safe and supportive environment also sees social workers and drug and alcohol counsellors provide health and rehabilitation advice and options to drug users in a way that enables changed behaviours in the longer term. The Greens propose establishing a pilot site in Adelaide, modelled on the effective Medically Supervised Injecting Centres operating in NSW and Victoria.
We know that the provision of information can assist young people reduce the risks associated with taking illicit substances as most information is sourced by peers rather than other avenues. We recognise this needs to occur in a way that is nuanced and aged appropriate. The Greens will work with experts to increase the provision of evidence-based and age-appropriate community education programs about drugs in schools and resource new community education programs to reduce risks and impacts of substance use.
We will also work with the sector over the next 6 months on a genuine co-designed infrastructure audit of the entire specialist alcohol and other drug service system to inform infrastructure needs in the medium- and long-term.
Whilst there has certainly been progress in implementing a national medicinal cannabis scheme over the past four years, reports on the ground are that patients are still having difficulties accessing the scheme. The Greens propose funding and support to enable more training for health practitioners to better understand how the medicinal cannabis scheme works, and which conditions it is suitable to be used for.
Increasingly we are also seeing mainstream health researchers turning to psychedelics and previously ‘illicit’ substances to treat a range of mental health conditions. Using clinical studies and peer reviewed results, these researchers are challenging preconceived and outdated judgements of these substances, and are progressing the field of psychiatric practice. The same can be said of the need for further work in understanding the full potential benefits of cannabis on physical health care. The Greens want South Australia to play a role in this important evolution, and explore what government support can be given to progressing new pilots and trials in the State. South Australia is well placed for such trials, through linkages with our academic institutions and health services, similar to mainstream trials already occurring in Victorian hospitals and around the world.
The Greens will:
|▲||Provide routine, free pill testing at festivals|
|▲||Establish and resource permanent pill testing sites|
|▲||Provide free and reliable intoxication level testing to support road safety|
|▲||Pilot a safe drug consumption site|
|▲||Improve drug education programs in schools|
|▲||Conduct an audit of community drug and alcohol services to establish future funding and identify pockets of unmet need|
|▲||Ensure dedicated support for First Nations people|
|▲||Enhance drug diversion pathways|
|▲||Ensure more training is made available for nurses, GPs and other health practitioners to better understand the medicinal cannabis scheme, and provide access to medicinal cannabis for their patients|
|▲||Increase investment in trials and research of medicinal drug use for treatment of mental health and PTSD issues|
Endometriosis and Pelvic Pain Centre for SA
The Greens will establish a centre for expertise in specialised endometriosis and chronic pelvic pain diagnosis, treatment and management in South Australia.
It is estimated that one in nine Australian women are diagnosed with this condition by age 44, yet there is still a shocking lack of research, treatment, and diagnosis options. Despite being as common as asthma or diabetes, endometriosis has been ignored and drastically underfunded, with it taking about 7 years on average to get diagnosis - and sometimes even longer for treatment.
There is a clear need for more trained health practitioners in South Australia so that patients can access interdisciplinary and holistic care. By having this specialist centre in South Australia we will provide more training opportunities for health practitioners, but it will also provide opportunities to partner with research organisations to evaluate the best treatment,diagnosis and training options. This centre would also ensure that no-one with pelvic pain is left behind, catering also to people with other types of pelvic pain and disease including PCOS, adenomyosis, and persistent pelvic pain.
Investing in Mental Health
We need to create a mental health system that is easy to navigate and promotes positive mental wellbeing, so when a person needs support - regardless of where they sit on the continuum of need - they can access it. South Australia’s mental health services have already been under great strain, and the COVID-19 pandemic has seen an increase in the need for mental health services. We need to provide more accessible, affordable and engaging services, filling gaps in the system and ensuring our mental health services are equipped to provide early intervention.
We need to focus on mental health at a personal and community level and ensure adequate funding is given to all aspects of mental health in South Australia. Mental illness is one of the biggest challenges of the 21st century. There has been chronic under-investment in the mental health sector by successive governments, which has resulted in the system failing to meet the needs of thousands of South Australians. Support during a crisis period saves lives, and yet these crisis services are often fragmented and difficult to access.
The Greens want to significantly increase funding for public mental-health services, including public hospital inpatient services, community-based outpatient and outreach services, and case managers, especially for patients with acute and pervasive mental-health conditions, including distinctive separate pathways for mental health patients to access emergency care where possible. This, we believe, would meaningfully address and alleviate issues of ramping and hospital overcrowding. Importantly, it would also ensure that people receive timely and appropriate care.
The Greens want clinical mental health service delivery to undergo reform, whereby models of care are adapted to include nurse practitioners in multidisciplinary team service delivery. As evidenced in other jurisdictions, the expertise they can bring will enrich and develop capability and quality of service delivery. Expanding mental health service delivery capability and workforce to include utilisation and integration of nurse practitioner scope of practice presents an opportunity to help provide coordinated care for mental illness, expand service delivery and grow the mental health workforce. Nurse practitioners offer a varied scope of practice and can provide complex case management, advanced assessment and interventions, and diagnosis and treatment of a variety of symptoms. Including this capability in mental health programs means patients can have other physical and medical health needs addressed, treating the patient holistically and potentially improving other health outcomes whilst receiving mental health medical care.
The Greens will improve access to psychological therapies by allocating $500,000 per year for a psychologist subsidy scheme for mental health care plan sessions. We know from talking to the community that a barrier to seeking mental health support is affordability, particularly for young people and for those who are vulnerable or on a lower income. The Medicare Benefit Scheme (MBS) rebate for psychology sessions is insufficient and does not support nor encourage people to access the psychological support they may need. This is particularly evident amongst already vulnerable and less financially well-off people and groups.
The Greens will create a psychologist subsidy scheme for young people and low income earners. South Australians 25 years and under, and healthcare card holders with a mental health plan will be eligible for this. This commitment targets the ‘mild to moderate’ category of mental health need, and we are aware that unfortunately this cohort often don’t proactively seek support due to cost.
The Greens also want to provide free seminars for parents and carers to provide advice and mental health training to support their young people. Delivered in school communities, the seminars will give parents knowledge and skills to help them understand the mental health challenges their young people are facing, skills to navigate the issues, and information on support services that are available. We will also provide funding for community organisations to deliver smaller parent peer support groups to assist parents and carers of young people with mental illness or disorder or at risk of developing a mental health concern. These peer support groups will help parents better connect with others who may be having similar experiences in their caring duties and may benefit from connecting and talking freely with others.
The Greens will:
|▲||Provide more support and services to address eating disorders|
|▲||Work with stakeholders and First Nations people to develop and deliver a First Nations Mental Health, Suicide Prevention and Postvention Program|
|▲||Improve services to address the co-occurrence of alcohol and drug use and mental health issues|
|▲||Improve respite for mental health carers|
|▲||Establish $500,000 of Mental Health Innovation Grants for innovative new programs that support the mental health and wellbeing of South Australians that can be delivered quickly, responding to needs in the community as they shift and change|
|▲||Reform clinical mental health delivery to include nurse practitioners in multidisciplinary team service delivery|
|▲||Establish a $2 million psychologist subsidy scheme for young people and people on low incomes|
|▲||Boost community counselling, mentoring, home visits, advocacy and case management for 10-25 year olds|
|▲||Free mental health training for parents, carers and peer support groups|
|▲||More funding and funding certainty for community sector delivery of youth mental health services|
|▲||Scrap School Chaplain funding and put that money into mental health programs for young people (psychologists, youth workers, social workers and other mental health supports)|