SA Health Governance Reforms frequently asked questions
What are the main changes?
The State Government has established 10 Local Health Networks (LHNs), each with its own Governing Board, which commenced operation on 1 July 2019.
From this date, six new regional LHNs have replaced Country Health SA LHN.
In addition, the Department for Health and Wellbeing (the Department) hass taken on a revised role, complementing and supporting the LHNs through high-level system direction and performance management, as well as its government departmental roles to support the Minister and Chief Executive in exercising their responsibilities.
Two other key Government initiatives have also been completed, being the establishment of Wellbeing SA and a Commission on Excellence and Innovation in Health on 6 January 2020.
For further information, see the Health System Roles and Responsibilities (PDF 316KB) fact sheet.
Why have the Governing Boards been established?
The South Australian public health system is a large and complex network of hospitals, health services and community based care. It has an annual budget of around $6 billion, over 38,000 staff, and delivers health services located across a large geographic area.
SA Health faces many challenges, including increasing demand on our Emergency Departments and health services, the prevalence of chronic diseases and people with complex health needs, and an ageing population.
Previously, SA Health was centrally managed, with all authority and accountability resting with the Chief Executive of SA Health.
Now, Governing Boards are responsible for decision making and accountability for local health services.
This enables us to be more responsive and innovative in meeting the needs of local communities, including how we support vulnerable people in our community.
The reforms will achieve better health service decisions tailored to local needs and deliver a safe, high quality and financially sustainable health system into the future.
What are the roles and responsibilities of the Governing Boards?
From 1 July 2019, each LHN has had a Governing Board responsible for the overall governance and oversight of local service delivery by the LHNs, including governance of performance and budget achievement, clinical governance, safety and quality, risk management and fulfilment of the Governing Board functions and responsibilities.
Governing Boards are responsible and accountable to the Minister for Health and Wellbeing.
LHN Governing Boards:
- manage local health service delivery that is safe, high quality and efficient
- monitor quality of health services
- be accountable for meeting performance measures in Service Agreements
- contribute to and implement system-wide plans issued by the Department of Health and Wellbeing
- maintain land, buildings and assets controlled and managed by the health service
- consult with health professionals working in the health service and with health consumers and community members about the provision of health services
- cooperate with other providers of health services, including providers of primary health care, in planning for, and providing, health services.
Governing Boards are responsible for appointing the LHN Chief Executive Officer, who will report to the board. Responsibility for the day-to-day operations of the LHNs remains with the LHN CEOs.
In performing their functions, Governing Boards are required to comply with directions issued by the Minister or Chief Executive, and any policies of the Department specified by the Minister or Chief Executive to apply to the boards in the performance of their functions.For more information see the Role of LHN Governing Boards (PDF 314KB) fact sheet.
What are the expected benefits of the reforms?
The expected benefits of the governance reforms are:
- Improved value in terms of quality and safety of services, costs and service accessibility
- Increased clinician and community engagement in service delivery
- Greater service responsiveness and innovation in the way services are provided
- Increased community confidence in our state’s public health system.
How will the benefits be achieved?
The expected benefits can be achieved by:
- A clear understanding of roles and functions, enabling better decisions and working relationships and partnerships across the system, including the Department for Health and Wellbeing as a system manager and LHNs as service providers
- A system that provides for greater decision making and accountability at the local level, to drive best practice and innovation in the delivery of safe and quality public health services across a range of settings
- A strong financial management and accountability framework that prioritises investment in high value, evidence-informed service responses and system sustainability at a local level
- A leadership culture that supports accountability, transparency, collaboration, and encourages innovation.
How have Local Health Networks changed?
From 1 July 2019, there have been ten LHNs, each with its own Governing Board, responsible for governance over local health service delivery. This allows decisions to be made closer to clinicians, consumers and communities, and support strengthened engagement.
Six new regional LHNs were established on 1 July 2019 to replace Country Health SA LHN, using regional boundaries that have been in place for many years.
- Women's and Children's Health Network
- Central Adelaide Local Health Network
- Southern Adelaide Local Health Network
- Northern Adelaide Local Health Network
- Barossa Hills Fleurieu Local Health Network
- Eyre and Far North Local Health Network
- Flinders and Upper North Local Health Network
- Limestone Coast Local Health Network
- Riverland Mallee Coorong Local Health Network
- Yorke and Northern Local Health Network
From an operational perspective, the LHN Chief Executive Officer (CEO) remains responsible for the day-to-day management and operations of the LHN.
The CEO reports to, and is appointed by, the Governing Board.
Each LHN continues to deliver the same services as it did before the reforms, in line with its Clinical Services Capability Framework profile.
How has the Department for Health and Wellbeing changed?
Yes. The Department has been realigned to ensure we can build our analytical and commissioning capability and develop into a world-leading Department for Health and Wellbeing.
The Department continues to have an important role in setting the strategic directions for the health system, and in supporting the Minister and the Chief Executive in exercising their functions and powers and meeting their obligations.
Due to the governance reforms, changes were made to the structure of the Department in 2019, so that it:
- Is more consistent in grouping of divisions around key system leader functions.
- Builds capacity and capability in new areas and functions.
- Is reflective of leading health department roles and functions.
Have there been changes for to Statewide Clinical Support Services and SA Ambulance Service?
There have been no changes to the governance arrangements of SA Ambulance Service and Statewide Clinical Support Services. SA Ambulance Service continues to be led by a CEO, reporting to the CE of the Department for Health and Wellbeing.
Statewide Clinical Support Services continues to be led by a Chief Executive Officer, and continues to sit within the Central Adelaide LHN from a legal perspective, with services provided to all LHNs.
What legislative changes have occurred?
To support progression of the Government’s priority to reform governance of the health system through devolving accountability for local service delivery to LHN Governing Boards, the Health Care (Governance) Amendment Act 2018 was passed by Parliament on 29 July 2018 and came into effect within the Health Care Act 2008 on 1 July 2019
Further amendments to deliver improved governance, by ensuring there are clear statutory roles, responsibilities and accountabilities across the South Australian public health system, were passed on 8 June 2021 in the Health Care (Governance) Amendment Act 2021 and came into operation on 23 August 2021.
See the Changes to the Health Care Act 2008 (PDF 235KB) fact sheet for further information.
What is Wellbeing SA?
Wellbeing SA was established on 6 January 2020 to oversee community-wide health and prevention services for all South Australians. It leads innovative system change to embed prevention across the life course and disease continuum, to improve physical, mental and social wellbeing and reduce the preventable burden of disease.
This rebalancing of the health system is a significant change from a system that focuses on treating people when they become unwell, to one that is based on promoting physical, mental and social wellbeing, preventing ill health and supporting people to maintain wellbeing and lead healthier lives.
For more information, visit the Wellbeing SA page.
What is the Commission on Excellence and Innovation in Health?
The Commission on Excellence and Innovation in Health (the Commission) was established on 6 January 2020 to provide leadership and advice on clinical best practice with a focus on maximising health outcomes for patients, improving care and safety, championing evidence-based practice and clinical innovation, and supporting clinical collaboration.
In doing this, the Commission:
- brings together expertise from clinicians, consumers, health partners and other relevant stakeholders to maximise health outcomes for patients
- is recognised as a centre for excellence, a strong partner for clinical improvement and innovation and will have recognised expertise which can influence design
- supports the provision of safer, more innovative and efficient healthcare through empowering clinicians and consumers.
For more information, visit the Commission on Excellence and Innovation in Health page.
What is Digital Health SA?
Digital Health SA has been established, incorporating what was previously eHealth Systems within the Department for Health and Wellbeing. It reports directly into the Office of the Chief Executive within the Department. Digital Health SA provides state-wide system support services, centralising our digital focus to allow the Department to make best use of available technology across our public health system.