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Regional boards: back to the future? 

medicSA July 2018 

The new SA Liberal Government is forging on with its proposal to restructure the SA health system, but there’s a flavor of ‘back to the future’ about it  ...

The party went to the election with a plan to decentralise the public health system by establishing metropolitan and regional boards. Each of the pre-existing metropolitan Local Health Networks is to have a governing board, as is the statewide Women’s and Children’s Local Health Network. In rural and regional SA, each of the six LHNs is to have a governing board.

Members who have been around a while will recognise a flavor of ‘back to the future’ in this proposal. While the concept may appeal to those who have chafed against centralised control impeding local decision-making, many questions about the new structure remain unanswered, including what will happen with statewide services such as SA Imaging, SA Pathology and Drug and Alcohol Services SA, among others.

Working to a deadline to have board chairs in place by 31 July 2018 the government brought a bill to Parliament on 7 June to establish board chairs, amending the Health Care Act. Better consultation has been a theme of the new government, and the restructure has been touted to deliver better clinician engagement via participation on boards, and a requirement for boards to have clinical engagement strategies.

In that context it was disappointing that the first Bill of this reform process was delivered to Parliament without much consultation apparent. The AMA(SA) swiftly provided a preliminary submission to government, Labor and the Greens, and attended a subsequent SA Health briefing.

In our first look at the Bill the first issue raised by the AMA(SA) was that the proposed boards should each include at least one member who is a medical practitioner, and that the board chairs should be medical practitioners.

We also raised questions about the accountability structure, and flagged issues for regional SA that would need to be addressed, as well as stressing that the cost to establish the new Boards should not reduce funding to country service delivery. We advocated for broadening the consultation and engagement strategy provisions to be more explicitly inclusive of the broader medical and health community – including GPs – and representative bodies. Interestingly, the amendments do not provide a ‘powers’ section for the boards.

This Bill merely represents ‘part one’ of a broader program of change; as with most legislation, much will come down to how it is interpreted and applied. The plan is that by the 2019-2020 financial year all regions will be operating under Service Level Agreements negotiated by Boards with the CE of SA Health, to “reflect local needs while recognising state-wide priorities”. The AMA(SA) will be awaiting the ‘stage two’ Bill with interest. Any members with feedback or concerns are encouraged to contact us.