As much as the Morrison Government might wish otherwise, the South Australian election result sends a clear signal that voters care about health and are willing to ditch incumbents.
The new Premier, , campaigned heavily on health issues and also prioritised health announcements soon after his election on 19 March, including changes to COVID governance arrangements and a review of the state’s Public Health Act. He stressed his determination to boost COVID booster vaccination rates and to align SA COVID policies more closely with national approaches.
His tweets since the election (see a selection below) also show him visiting a hospital, and said that his priorities include implementing a state-based version of the Uluru Statement from the Heart – including Truth, Voice and Treaty. He also tweeted that “Health remains my #1 priority”.
Chris Picton, whose CV includes former roles as Adviser and Chief of Staff to the former Federal Health Minister and Attorney-General, Nicola Roxon, and Chief of Staff to former SA Health Minister John Hill, will be the Minister for Health and Wellbeing.
So what are the implications for the Federal election and the health of South Australians, at a time of escalating COVID case numbers and intense pressure on SA hospitals?
Croakey asked some experts for their views on these questions, and they also provided some informed health advice for the new Premier.
Hope and vision
Health policy analyst and Croakey columnist Associate Professor Lesley Russell
Q: What are the implications of the South Australian election result for health and the federal election?
Healthcare issues are top of voters’ agenda – and they want to see a commitment to the future through initiatives that will improve their lives and communities.
Q: If you were writing a briefing paper on health for the new South Australian Premier, Peter Malinauskas, what would be its headline?
Actions now imperative – short, medium and long term goals and initiatives.
Q: Any other related comments?
Malinauskas has been beautifully able to convey – with sincerity – why he wants power and what he will do for South Australia in power and he presented a policy agenda to back this up. See his acceptance speech.
It’s a long time since we’ve heard this sort of public commitment in politics, and voters are clearly responding.
His approach to tackling the issues may also help drive a more bipartisan national approach to addressing the wicked problems – poverty, housing, healthcare financing, aged care, emergency preparedness, etc – that beset the federation.
He brings hope and vision at a time when these are sorely needed. But he will quickly be tested as he looks to implement his program – and then we will see what he is really made of.
Housing is the big health issue
Aboriginal Drug and Alcohol Council CEO Adjunct Associate Professor Scott Wilson
Q: What are the implications of the South Australian election result for health and the federal election?
I think that South Australia is angry at the Prime Minister and the Morrison Government, and basically can’t wait to wake him at the federal polls. If the Federal election had been held before the SA election, there might have been a different outcome.
I think Federal Labor will pick up additional seats here in SA and do well if they stick to issues that resonate with the electorate such as health and climate change. If he is smart enough, Albanese could learn from how Malinauskas hammered a few issues, and kept a really small target.
In terms of state health policies, you didn’t really hear too much about policies from either sides (link to attached summary of policies). The Liberals were offering to build a new inner city basketball/entertainment facility, which ALP latched onto by couching everything they were going to do in that they weren’t spending $662 million on a basketball stadium.
Labor’s catch cry was to end ramping of ambulances at hospitals, and they were very disciplined in their messaging. I wonder whether the extra nurses and doctors etc will still be around in four years or will we see wards being closed to compensate for the extra payroll bill?
Labor made a $3.5 million commitment for additional rehabilitation beds in Port Augusta, which we are happy about. But we’d be looking for so much more in policies for drug and alcohol rehabilitation.
Q: If you were writing a briefing paper on health for the new South Australian Premier, Peter Malinauskas, what would be its headline?
Housing is your biggest health problem to solve. Commit $1 billion to affordable, social housing in SA, and this will go a long way to addressing alcohol and drug issues and have positive benefits on the health of all South Australians.
In metropolitan, rural and regional SA there is a total lack of public affordable housing that has led to overcrowding, homelessness and other chronic health issues.
Also, raise the age of criminal responsibility to 14.
Tackle the iceberg
Health policy analyst and Croakey editor Jennifer Doggett
Q: What are the implications of the South Australian election result for health and the federal election?
It is clear that ramping was a major issues for voters in the SA election and one reason for the Labor landslide. This suggests that voters are concerned about the state of the health system and will punish governments which fail to deliver adequate health services.
Both federal and state governments are responsible for the drivers of ramping, a complex issue and a symptom of wider structural problems with the health system. Logically, voters in states experiencing problems in public hospital and ambulance services (in particular SA, WA and Victoria) should penalise the Federal Government for its failure to address the drivers of demand for emergency care (such as inadequate support for aged care, disability services, mental health and general practice to prevent problems from escalating to emergencies).
Voters typically blame state rather than federal governments for health services failures, however, so this pattern may not be repeated at the federal level where voters tend to prioritise economic and security issues.
However, given the Morrison Government’s repeated high profile failures in the health and ageing portfolio (an inconsistent COVID response, delays in the vaccination program, ongoing problems in aged care), it is possible that voters will follow the lead of South Australia and desert the LNP at the upcoming poll.
Q: If you were writing a briefing paper on health for the new South Australian Premier, Peter Malinauskas, what would be its headline?
Ramping is the tip – the problem is the iceberg.
Q: Any other related comments?
Community concern about ramping provides an opportunity for state and federal governments to work together to address some key challenges in our health system.
However, this will require challenging some of the vested interests in this sector as well as reducing incentives for cost-shifting across areas of federal/state responsibility. Previously these have proved to be insurmountable barriers for governments wishing to take pressure off public hospitals and to improve the efficiency and effectiveness of our public health system.
Positive campaigning on health is a winner
Dr Chris Moy, Adelaide GP and current Federal Australian Medical Association Vice-President
Q: What are the implications of the South Australian election result for health and the federal election?
That the parties would be well advised to not to be caught up in focussing on the machinations and political strategies surrounding the SA election and realise that the election was won by campaigning positively on one issue which means a lot for the average person on the street: Health.
The SA election was a tangible electoral confirmation of what we have seen in story after story, and poll after poll, in the media: that health is a priority to Australians, and they expect that the health system to be there for them when they need it, and that they can see that it is not. Politicians that are deluded into thinking that “COVID funding was health funding done” run the grave risk of their showing disconnection from their constituents who, in the SA Election, could see the ramping caused by their local hospitals in constant logjam, and therefore voted for positive change. COVID only focussed the community on how important their health system is, and this crystallised into votes.
Q: If you were writing a briefing paper on health for the new South Australian Premier, Peter Malinauskas, what would be its headline?
Health is an investment, not a cost, dummy.
Q: Any other related comments?
Any attempt to increase health system capacity and lift our hospitals out of logjam also requires a willingness for States to work together with the Federal Government on funding our health care system. That is why AMA have called on a commitment from all State and Territory Governments to end the blame game, move to 50/50 funding, but not reduce their own contributions to hospital funding.
And just as importantly, we need urgent investment in primary care – our nations GPs – in order to reduce the demand on our hospitals, and to improve our preventative health and management on the increasing number of people with chronic diseases. Without an investment in general practice, we risk being caught in an ongoing cycle of crisis in our health system.
Invest in community health centres
Professor Adrian Esterman, Chair, Biostatistics and Epidemiology, University of South Australia
Q: What are the implications of the South Australian election result for health and the federal election?
I think the Marshall Government did a pretty good job at managing COVID until last November, when they opened the borders against the advice of Professor Nicola Spurrier, our Chief Public Health Officer. Until then, she was giving daily press briefings, but has hardly been seen since.
It was therefore encouraging to see our new Premier Peter Malinauskas meet with Nicola and the Department of Health CEO Chris McGowan to discuss the current COVID situation in South Australia. Hopefully, he is more willing to listen to public health advice than his predecessor.
I am not in a position to talk about the impact of the SA election result for the Federal election.
Q: If you were writing a briefing paper on health for the new South Australian Premier, Peter Malinauskas, what would be its headline?
Why ignoring public health advice can be costly.
Q: Any other related comments?
Malinauskas has said today that it will take many years to fix the ramping problem. It is caused by bed blockage – lack of inpatient beds causes blockages in the ED which leads to ramping. One of the main reasons for bed blockage is that many beds are taken up by frail elderly people and people with poor mental health, who shouldn’t be in a major acute care setting.
Instead of spending a couple of billion on a new Women’s and Children’s Hospital, why not build some more community health centres which would take mental patients requiring short-term stays, and build some more Residential Age Care facilities?
Focus on prevention and determinants
Professor Fran Baum, University of Adelaide
Q: What are the implications of the South Australian election result for health and the federal election?
The ALP ran a campaign that focused on the crisis of ambulance ramping at emergency departments at the major hospitals. During the campaign Malinauskas was often seen with ambulance paramedics and had incredibly strong support from them. The ambos have been running a campaign on the crisis of ramping for around two years. A very high percentage of the workforce are union members and their campaign really highlights the union benefits of strength in numbers. One way this was highlighted was that many ambulances have had campaign messages written on them (see image below) (much to the frustration of the Liberal Government who were unable to stop this practice because of the high level of union membership).
Labor kicked off their campaign by promising 300 more hospital beds and 100 more doctors Labor kicks off campaign with hospital beds pledge – InDaily.
So health was top of the agenda for SA Labor but was very medical, downstream and curative. No attention was paid to stopping the increasing pressure on emergency departments or demand for hospital beds. The voice for prevention and comprehensive primary health care services was silent. So the implications for SA are that we will continue to provide more acute care services and this will mean the beds will be filled and there is still likely to be a crisis.
There is little hope for a health system based on health promotion and disease prevention when acute care is seen as the solution to the perceived crisis in the health care system. The SA Election made it very clear that voters do value accessible acute care services very highly and arguing for long-term prevention is not likely to win many votes in the face of powerful lobby groups – the ambulance unions and the medical lobby.
I would love to see the Federal ALP promising a Community Health Program offering community managed and controlled health services which offer aged care, palliative care, curative PHC. Community mental health and then a range of disease prevention and health promotion activities relevant to local communities.
I hope SA Labor will continue to support Wellbeing SA and funded it sufficiently to do health promotion and diseases prevention work as their central focus. Hopefully, the focus on wellbeing can be picked up by the Federal ALP and if they win government and they can establish a national disease prevention and health promotion agency that really moves beyond behavioural change focus to one that seriously considers social and commercial determinants of health and use approaches such as Health in All Policies. Perhaps we could even have a wellbeing budget and begin to monitor national progress in a way that takes in health and wellbeing and not just economic measures.
A key message for Albanese is that the positive view of the future is appealing to voters. The trick is in conveying that message – Malinauskas had the advantage of being young; Marshall isn’t old but came across as jaded compared to him. He is also so very energetic and this provides a sense of energy and can-do spirit. People have talked about his charisma too.
Q: If you were writing a briefing paper on health for the new South Australian Premier, Peter Malinauskas, what would be its headline?
You have won government on the back of your campaign on acute care services. Now you have four years to ensure that SA takes the measures needed to prevent the flow of people into our acute care services and which will make us a healthier populations.
To do this these are some of the measures you can take:
• Refund community controlled community health centres that take a whole of population perspective in their communities and offer mental and physical health services which will help stem the flow to emergency departments. The aim could be eventually to have comprehensive services which offer early childhood services through to older peoples’ health, aged care NDIS services (under public control) and palliative care. Learn from the terrific network of Victorian Community health services.
• Extend funding for neighbourhood houses through local government to provide places people can meet connect and socialise – these would be great sites of health promotion and help to keep people out of hospitals especially in terms of mental health and they could work closely with Community Health Centres. This would be an investment that in a few years would save us money for acute care services.
• Re-energise the Health in All Policies approach taken under the Rann Labor government. Use this to engage all sectors in making all SA government sectors aware and accountable for their health impact. Our evaluation showed that HiAP is most successful when you as Premier take carriage of this, support it strongly and ask for all Department heads to report their progress towards health and health equity annually. SA could easily be a world leader in HiAP and achieve an aim to become the healthiest region in the world
• Establish a high profile Health and Wellbeing Council to advise a) how we can reduce reliance on acute care services b) how we can best promote health and health equity in our State. Learn from the Queensland and Tasmanian experiences
• Fund Wellbeing SA to take action in all areas where prevention is possible including and not limited to injury prevention, healthy weight, road safety, action on social determinants including housing security, food security, employment opportunities and commercial determinants of health (including reducing conflicts of interest created when industry is too close to governments) and especially measures to control ultra processed foods, alcohol and tobacco.
• Establish processes to produce health policy which has been largely absent in recent years – this should be in the areas of gender and health, poverty and health, migrant and refugees, Aboriginal health, housing and health.
• Establish a state wide monitoring unit on understanding the drivers of health equity and make a determination to ensure that health equity does not go on increasing in SA as it has since 1990.
• Introduce a sugar tax on sweetened beverages – this will help reduce overweight and obesity in our population
• Ensure that the early childhood development initiatives you are going to introduce are distributed across the city but start in the most deprived areas – and look at the health promoting features you can introduce – free healthy meals, linking with child health services supporting parents with their parenting tasks.
• Reintroduce a research branch in SA Health which particularly focuses on population health and works with the universities and NGOs (Heart Foundation, Cancer Council etc) to write a comprehensive SA population health research strategy
• Re-instate funding for the SA Consumer Health Forum which was cut by the Liberal government and take advice from SACOSS on the best model to use as they are just completing a project which will enable them to provide very sound advice.
Q: Any other related comments?
The other noticeable thing about Peter Malinauskas’ campaign was that it was positive and focused on a fairer future. He offered a vision of a fairer recovery from COVID. My observation is that he was an extraordinarily hard-working leader of the opposition and for the last 18 months has been very prominent on the news.
He came across as positive and visionary even though he campaigned so heavily on the crisis in the health system. I’d like to think his emphasis on being fairer was popular and part of the reason they had such a big swing. The Liberals ran a scare campaign on ALP spending (see picture below)but that didn’t seem to cut through.
Holistic approaches needed
Kylie Woolcock, Acting Chief Executive Officer, Australian Healthcare & Hospitals Association
Q: What are the implications of the South Australian election result for health and the federal election?
The South Australian election result has highlighted the importance Australians place on health.
Quality health services was a key policy underpinning the SA Labor party campaign, with specific measures identified in terms of increasing workforce, beds and infrastructure. Commitments have been made to improve access in emergencies as well as addressing rural inequities.
However, dysfunction identified in the health system cannot be solved by focussing on any one part in isolation. Take the identified ramping crisis. More paramedics and ambulances are only the start of the solution – and Labor’s policies recognise this.
Considering a holistic approach will require the incoming government to drive the health system to measure what matters. This involves care outcomes being accurately reflected and can used to support decisions, both for patients in making decisions with health care providers, through to informing improvements in the performance of the health system overall.
Increasing the number of doctors and nurses is also an important investment identified by the incoming government. It must be remembered, however, that our health workforce involves so many more roles, both clinical and non-clinical, who all need to work together to improve the outcomes that matter to people and communities.
Health policies must keep pace and support our workforce to provide care for people in ways that may previously have been unimaginable. We need governments to be thinking beyond the adequacy and distribution of the workforce as it currently exists – and recognising the diverse skills and expertise needed and providing incentives for working together.
Q: If you were writing a briefing paper on health for the new South Australian Premier, Peter Malinauskas, what would be its headline?
Healthcare is more than a state issue – action must put people and communities at the centre
Boost primary healthcare
Leanne Wells, CEO, Consumers Health Forum of Australia
Q: What are the implications of the South Australian election result for health and the federal election?
The SA election was contested with health front and centre. It shows that the community rate health and responsive health services highly. They expect their governments to invest in health, so we can expect to see a contest of ideas for health system improvements and investments carry over into the federal election
Q: If you were writing a briefing paper on health for the new South Australian Premier, Peter Malinauskas, what would be its headline?
Refund a peak health consumer body – HCSA was defunded in 2018 at a time when it couldn’t be more important that patient voices are at the table. An OECD report on building people- centred health systems, Health for the People, by the People, found that patient voices are weakly embedded in the system.
Address ED demand (ambulance ramping) by funding LHNs and PHNs to work together to put in place hospital avoidance programs and services.
Invest in upstream healthcare like preventive health and wellness programs and work with the Commonwealth through a collaborative agreement to boost the capacity and access of primary healthcare services, particularly in rural areas.
Health is a whole-of-government responsibility
Ross Womersley, CEO, SACOSS
Q: What are the implications of the South Australian election result for health and the federal election?
One of the things we’d hope to see is greater clarity about the roles of state and federal jurisdictions and better still, a much stronger synthesis between the resources and effort so as to ensure much stronger delivery of primary, public and preventative health service delivery. Similarly, we would like to see strong independent monitoring and analysis with a social equity base which drives accountability in our health system.
Q: If you were writing a briefing paper on health for the new South Australian Premier, Peter Malinauskas, what would be its headline?
Watch out for the crocodiles – Prevention is indeed better than cure but it won’t happen without genuine investment.
Q: Any other related comments?
Demand for our health system needs to be understood as having a strong relationship to all the social determinants of health and with that in mind, all those other areas of government endeavour responsible for those determinant activities need to prioritise population health as one of their key deliverables.
Invest in prevention
SA Public Health consortium
Q: What are the implications of the South Australian election result for health and the federal election?
The Labor party has committed to the health of South Australians as their number one priority. Voting by South Australians has shown strong support for this. SA Labor committed to addressing key issues such as hospital ramping, lack of ambulance services, and increased funding for mental health support in schools and investment in the healthcare workforce and infrastructure.
From a public health perspective, key promises included a commitment to establishing a new independent preventative health agency, reintroducing the RiteBite policy to promote healthy eating in schools and resourcing the Health Performance Council to monitor and report on health inequities across South Australia, with the aim to improve social determinants of health and equity across the system.
We hope that the government will also act to re-orient at least five percent of our health budget toward prevention of ill-health to work further upstream and prevent ill health in the first place. We would also like to see this government work on health promoting environments as we know these play a critical role in improving health behaviours. A first step would be restricting advertising of unhealthy items on government property.
The SA Labor Party’s election campaign was driven by a focus on health. This should be a key learning for both the federal Labor and Liberal parties going into the next federal election. Voters expect and value investments in health above all else, which was made evident by the SA Labor party’s victory.
Q: If you were writing a briefing paper on health for the new South Australian Premier, Peter Malinauskas, what would be its headline?
Too many South Australians are entering our health system unnecessarily and we need to address this issue upstream. Chronic diseases can be prevented through a commitment of at least five percent of health expenditure on disease prevention and health promotion.
Health in All Policies is vital
Mark Burdack, Chief Executive Officer, Rural and Remote Medical Services, Adjunct Senior Lecturer, School of Rural Health, La Trobe University
Q: What are the implications of the South Australian election result for health and the federal election?
The state of health service was the defining issue in the South Australian election, as it was in the Bega byelection in rural NSW. I think Australians are fed up with the failure of governments across the board to genuinely address the decline of our health and hospital system.
While ambulance ramping was the headline issue in the SA election, I think this was symbolic of wider concerns. More than 80 percent of Australians see a GP every year, and this is where people experience the problems of our healthcare system first hand. GP shortages are resulting in longer wait times and increasing out of pocket expenses. In rural and remote towns, communities are losing access to health care completely.
I think Australians are seeing through the hollow announcements of new hospitals when there are no doctors to staff them, or an expansion of GP training programs in rural areas when we know that we don’t have enough medical graduates to fill the training positions we have now. I think the message from South Australia is very clear – Australians want serious health reform and follow-through on commitments.
Q: If you were writing a briefing paper on health for the new South Australian Premier, Peter Malinauskas, what would be its headline?
Strengthen “Health in all Policies” to drive health and hospital reform
Q: Any other related comments?
Like all States and Territories, South Australia is confronting the impact of two decades of failed rural medical workforce programs. Far from fixing rural GP shortages, these programs have contributed to even fewer medical graduates wanting to become GPs (down to just 15%).
This has contributed to a decline in access to primary health care, and an increase in demand for hospital emergency services to fill the gap placing a disproportionate burden on the State health budget. States need to take control of primary health care and medical workforce development by seperating the administration of hospitals and primary health care in their jurisdictions. “Health in all Policies” is no longer a ‘nice to have’ but will be an essential tool for Treasuries to drive down hospital demand and costs by improving community access to primary health care.
Implementation is key
Health policy analyst Charles Maskell-Knight
Q: What are the implications of the South Australian election result for health and the federal election?
Not being a South Australian it is hard to provide a well-informed answer to this. From the outside it looks as if the previous Government did not address unacceptable and dangerous shortfalls in ambulance services, and the opposition was able to capitalise by promising to fix an ongoing problem.
There are no equivalent ongoing federal government service delivery failures. While it is responsible for the vaccine strollout and the RAT debacle, not to mention the aged care catastrophe, these have either passed or not caught the public imagination.
Q: If you were writing a briefing paper on health for the new South Australian Premier, Peter Malinauskas, what would be its headline?
Health election promises: implementation.
And there would be a very clear section setting out implementation risks, including workforce difficulties, physical infrastructure constraints, and financial implications.
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See Croakey’s coverage of the SA election and health.
