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Health | September 06, 2018

Safe patient care (nurse to patient and midwife to patient ratios) amendment bill 2018

Debate resumed from 22 August; motion of Ms HENNESSY (Minister for Health).

Victorian Parliament - 6 September 2018 - Ms KEALY (Lowan) (15:58:39) — I rise to speak on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2018. It is somewhat surprising that, given what we have heard from the Labor government about this bill and how important it is, we have been left only 1 hour on the last sitting day of the week to debate this. I am somewhat shocked. I think it is disrespectful to the nurses, the midwives, the other health professionals and of course the patients who will be impacted by this bill.

I was ready to debate this bill early yesterday. To think that we have been debating such issues as have been reported in the media as a priority over what has been purported to be one of the most important bills in this term of government is quite astounding to me. I think that nurses, midwives and patients deserve a lot more respect than political pointscoring in what was otherwise a pointless debate.

Something else has come up which is deeply concerning to me. This is called a safe patient care bill. In my experience working in the health sector one of the fundamental ways that you can support safe patient care is ensuring the safety, the integrity and the security of private and confidential health information. I was absolutely disgusted to see that personal health records have been released by this government and to hear, earlier today, the Minister for Health nonetheless backing this in and defending the actions of this government in releasing these documents to the public without them being redacted in any way, with personal information included in that. Mental health information, very sensitive information —

Ms Williams — On a point of order, Deputy Speaker, the member for Lowan is straying from the subject of the bill quite substantially. She is talking about a totally unrelated issue, and I urge you to bring her back to the bill.

The DEPUTY SPEAKER — Order! Member for Lowan, I ask you to return to the bill.

Ms KEALY — As is outlined in the second‑reading speech provided by the minister:

This bill will improve workload arrangements and have a significant and lasting impact on the provision of safe, empathetic and high‑quality patient‑centred care in line with community values.

And I think that the community values of every single Victorian are that when you speak to a health professional, when you have any blood test, when your HIV or hepatitis status is known, when you have had perhaps some fertility treatment, if you have had a termination of pregnancy, if you have got drug treatment records, if you have been in the drug injecting room in North Richmond or if you have a record of any chronic or acute illnesses that may preclude you from employment or jeopardise your workplace, you certainly have a right to have that information kept private and confidential. And I have seen the most gross breach of that in my experience within the health sector —

Ms Williams — On a point of order, Deputy Speaker, the member for Lowan continues to defy your previous ruling. I again urge you to bring her back to the substance of the bill. She is again speaking about an entirely unrelated matter, which I would say is offensive to the nurses, midwives and other health professionals who are affected by this legislation and who have been calling for it for a significant period of time, the same people who were represented strongly here last sitting week when they came to see this bill introduced into Parliament.

Ms KEALY — On the point of order, Deputy Speaker, this bill is called the safe patient care bill. Within the second‑reading speech put forward by the minister it is clear that this will have a lasting impact on the provision of safe, empathetic and high‑quality patient‑centred care in line with community values. I was actually making that exact argument, that securing the private and confidential medical information of Victorians is completely in line with community values. Therefore all of my comments are absolutely in order and need to be put forward today.

Ms Hennessy — On the point of order, Deputy Speaker, this is a bill about nurse‑patient ratios. In my submission you should indeed lead the lead speaker for the opposition back to keeping her contribution to the content of the bill, and we would welcome your intervention to that end.

Mr Clark — On the point of order, Deputy Speaker, the member for Lowan is making the point that the house is being asked to agree to this bill as a measure to improve patient safety. The member for Lowan is entitled to talk about what matters are important for patient safety and to assess this bill in the context of a range of measures that she is entitled to argue should be attended to by the government in order to secure patient safety. In doing that, she is perfectly in order with the bill. Just as the Speaker ruled that the comparison and contrast of matters were relevant on the motion that we have just been dealing with, comparing and contrasting different measures that may contribute to patient safety are fully in order in relation to this bill.

Mr Foley — On the point of order, Deputy Speaker, with the greatest of respect to the member for Box Hill, a censure motion with its wider set of parameters is one thing when it comes to compare and contrast, but in this space — even allowing for a lead speaker having some latitude on a bill — this bill is very specific. It deals with safe patient care, nurse‑to‑patient and midwife‑to‑patient ratios. It is not an opportunity for the lead speaker of the opposition to go on a wideranging, opportunistic attempt to take this debate well beyond the breadth of the bill. With the greatest of respect to the member for Box Hill and the member for Lowan, the point of order that the member for Dandenong has raised here should be supported, and the member for Lowan should be invited to stick to the narrow confines albeit allowing for a wideranging contribution from a lead speaker of the opposition in this space.

Ms Ryan — On the point of order, Deputy Speaker, it is well established in this place that a lead speaker has a degree of latitude on a bill, as the Minister for Mental Health has just pointed out. The member for Lowan was being entirely relevant to the bill in talking about the safety of our health services and community values with respect to that. It is a shameful reflection on those opposite, after wasting the time of this house for hours on a motion about the Leader of the Opposition, that they would now seek to shut down the member for Lowan. It is not the fault of those on this side of the house that they have given themselves barely an hour to debate a bill that they have been telling us is of great importance. It is now perfectly within reason for the member for Lowan to give her contribution as she sees fit. She is a former health professional and well across the issues contained within this bill and the issues of safety within the health system.

The DEPUTY SPEAKER — I will rule on the point of order. It has been the practice of this house traditionally that lead speakers do have some latitude in respect of the bills that they are speaking to; however, I do ask the member for Lowan to be mindful of the content of the bill.

Ms KEALY — Thank you very much, Deputy Speaker. In relation to the way that we provide safe care, particularly in hospitals, nurses and midwives do an absolutely amazing job, and I have certainly worked amongst some of the finest. I pay credit to all of the nurses that I have worked with and have had the benefit of being in contact with. In particular I make note of my fantastic midwife, Sarah, who I caught up with under not‑so‑great circumstances recently after she was impacted by the bushfires earlier this year. Thank you so much, Sarah, for all of your amazing support for me over my pregnancy and in the safe delivery of my lovely little boy, Harvey.

In relation to nurses and midwives, they do go to every length possible to support their patients. One of the fundamental things that you are taught when you enter into the health services is the importance of treating every piece of health information you have with the utmost respect. You know the consequences of releasing certain information to the public. It can be very difficult when you are in country areas. You know everybody that you deal with. In particular you are often in contact with very, very sensitive information, and there is an enormous amount of weight put on the essential element of keeping certain medical information private and confidential. This is one of the fundamental parts of being a good professional.

Again, I am deeply concerned that nurses have been completely disrespected over the last few days in that their respect for the way in which our health records are maintained has been completely thrown out the window and violated by the Andrews Labor government.

Ms Williams — On a point of order, Deputy Speaker, we are now over 10 minutes into this contribution, and the member for Lowan is still speaking on a matter that is unrelated to the bill. I think we have been quite clear that this bill is about nurse‑to‑patient ratios. It is a bill that is of extreme importance in our health sector, with a stakeholder group that is keen to see members in this place speak to this issue in a meaningful way rather than politicking, which quite frankly there has been plenty of opportunity to do in the previous proceedings in this place. I remind the member for Lowan that this is a bill contribution and not the censure motion, and she should address her commentary to the substance of the bill, which is fundamentally about nurse‑to‑patient ratios.

Ms Ryan — On the point of order, Deputy Speaker, this is a blatant attempt by the member for Dandenong to waste the member for Lowan’s time as the lead speaker on this debate. In her second‑reading speech the minister said that this this bill will create positive, healthy and productive environments and advance the health system for better patient safety, deliver the best outcomes for all Victorians and also provide safe, empathetic and high‑quality patient care in line with community values. That is directly the point to which the member for Lowan is going, because you cannot just leak the private and confidential, sensitive, personal health information of everyday Victorians and expect that it will be okay. That is the point that the member for Lowan is going to, and she is entirely entitled to do so within the context of this debate and the minister’s second‑reading speech.

Ms Hennessy — On the point of order, Deputy Speaker, I think that the member for Euroa has certainly belled the cat in terms of the lead speaker’s contribution on this bill. Reference was made to the second‑reading speech, and I note that it was a convenient extraction from the second‑reading speech, because the second‑reading speech is linked to and goes to ratios between nurses and patients. We are now 17 minutes in on the lead speaker’s time. We have not got to any form of the content of the bill. With the greatest of respect to the lead speaker, I would absolutely urge you, Deputy Speaker, to draw the lead speaker on behalf of the opposition back to the content of the bill. There has been a fair and adequate opportunity for them to canvass the issues that they clearly wanted to canvass, as revealed by the member for Euroa, but the opportunity now — with almost less than half of the allotted speaking time left — is to come back to the technical and substantive content of the bill.

The DEPUTY SPEAKER — No more points of order? I rule on the point of order that the member for Lowan has been given quite a considerable amount of latitude. I do ask the member for Lowan to come back to the bill.

Ms KEALY — The sheer irony that I am being told that I have wasted my time when members of the Labor government are the ones who are on their feet raising frivolous points of order rather than wanting to talk about the need to improve patient safety by adhering to privacy and confidentiality, which are fundamentals of a safe health system in Victoria, is a disgrace and a blight on this government and shows how political things are getting in this. I do not think you can accuse one side of this without having a good, hard look at yourselves and seeing how you are raising time‑wasting points of order.

There are a number of issues that we do have with this bill, and I would like to go through them. Again, we need to ensure that we do support our fantastic nurses and midwives. I reiterate my strong support for the medical community, including the nursing community and midwives, who do an amazing job in all of their efforts to provide the best clinical outcomes for patients to ensure that they are cared for during their time in a healthcare setting, at home or in another environment. They do a great job to adapt to that and to make sure that people get not only the health care they need but the emotional support they need as well. I thank each and every nurse and midwife for doing that.

The concerns that have been raised with me about this bill are around how we will actually fund this. There is an intention for this legislation to come into effect in six months. There has been some information provided as to how this will be rolled out. However, hospitals are yet to be told when that money will flow, how this will be delivered or even how much they will receive, which is leaving a huge number of questions on workforce recruitment to be answered.

Obviously if this is going to result in a significant increase in salary and wage costs for a health service, then they will have to make that decision. Do they cut back the number of beds that they have and the services that they are able to provide to the community, or do they look at perhaps breaching this legislation? Or are they just going to have to beg the government for more money and hope that that finally is delivered? I do not think that patients in Victoria deserve that level of uncertainty. I think that it is quite cruel on the nursing community as well not to have a clear understanding of how this will be funded over the coming five years. I do urge the government to be more forthcoming with the full budgeting for how these legislative changes will be funded so that it can be properly delivered by our healthcare sector.

Something that is certainly also true in my part of the state in western Victoria is that there are significant workforce shortages, particularly in the clinical environment, including nurses. They are incredibly difficult positions to fill. These increased ratios are going to put additional pressure on this workforce shortage. While there has been some money put aside to assist with recruiting nurses, there is really not a plan for how we can ensure that trained nurses do make it out to rural and regional areas. We have not seen a health workforce strategy drawn up by this government, and unfortunately it is becoming harder and harder to attract clinical professionals to the rural and regional areas of Victoria. As a result, positions are vacant for extended periods of time, which puts a lot of additional pressure on the existing workforce through increased demands on people to do overtime, which really wears people out in an unnecessary way.

We need to properly make sure that we have got enough people in the workforce trained not just for today but for the future to make sure that nurses are well supported but also that patients receive the quality of care that they deserve. While this bill of course is putting ratios into legislation, the ratios will not necessarily be delivered in a full and proper way if those costings are not there and if the workforce is not there. This is something that I know is of great concern to many nurses right across the state — nurses who have raised this issue with me directly.

There is also a concern that this will drive up recruitment costs, and given the removal of understaffing provisions and redistribution, if a health service with workforce challenges is unable to reach an agreement with the Australian Nursing and Midwifery Federation, they will be forced to spend on recruitment and face the consequences of non‑compliance or even have to close beds. This would be extraordinarily damaging for the health sector. We just simply cannot afford to be closing beds across the state. We cannot afford in our health system to be forced to spend more and more money on administration, including recruitment, rather than delivering the health services that Victorians need.

It costs a lot of money to transfer patients. Should there be further bed closures across the state, putting somebody in an air ambulance, whether it is a fixed‑wing or an air wing, or even transferring them by road is a huge additional burden, which comes of course out of the government’s spend. It is a huge extra cost. Sometimes those additional costs for patient transport do go back to the hospital as well. Again, it is another hit on a hospital, and sometimes it is very, very difficult to make ends meet and to make sure that you are able to deliver the maximum number of patient care services rather than pouring all your money into other administrative functions of the hospital, whether it is into recruitment or whether it is into providing further details and data to the government for number crunching — and you get no information back, which anyone who has ever been an administrator in a hospital has experienced.

We need to make sure when we do set up any legislation or any structural framework for delivering health services in this state, particularly within a hospital, that as much money as possible can be moved away from bureaucracy and put into what really matters, and what really matters is that we provide the health care and the care that patients need and patients deserve to keep them well or to help them get well if they are unwell. Something that is more important than anything else is how our patients are supported in Victoria.

I will also refer to the way that nurse‑to‑patient and midwife‑to‑patient ratios will impact on special care nurseries. This was something that was raised by the member for Sandringham, who is a fantastic local member and who always puts an enormous amount of work into scrutinising legislation. He has come forward with some concerns, and I ask the minister to consider making some changes to tidy up the legislation prior to its carriage to the upper house — or perhaps it is an amendment that could be made in the upper house. This is in relation to substituted section 27, ‘Special care nurseries’, of the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015. So in clause 10, section 27 substituted reads:

(1)   The operator of a hospital must staff a ward that is a special care nursery as follows on all shifts—

(a)   in the case of a special care nursery with 9 or fewer occupied cots—

(i)    one nurse; and

(ii)   for every 4 additional occupied cots beyond 4, one person, being either a nurse or a midwife …

A concern that has been raised by a constituent of the member for Sandringham, who has subsequently and diligently forwarded it onto me and the shadow Minister for Health in the other house, Ms Wooldridge, is that there are concerns that in this context a midwife is not necessarily a nurse if they have qualified in the first pathway of going through an accreditation scheme, rather than a midwife who has qualified through other pathways — that is, they may not necessarily be registered as a nurse as well as a midwife.

It is the position of the member for Sandringham’s constituent that the language of the clause places midwives in a subordinate position to nurses. I do not think this is the intention of the bill. I do think there is the intention that it is equitable, and that nurses and midwives are treated equally in that environment. I do believe that is how it operates in practice, but in this current version of the clause a midwife holding a bachelor of midwifery would become reliant upon the presence of a nurse in the special care nursery, despite being highly trained in postnatal, maternal and newborn care themselves. I ask the minister to review that clause and consider an amendment to substituted section 27(1)(a)(i) so that it be amended from ‘one nurse’ to ‘one nurse or midwife’. I think that will ensure there is equal respect for nurses and midwives, and it will provide the respect for the particular skills and qualifications that midwives have and the support and care they provide in special care nurseries. If this was considered by the minister it would be appreciated, or if she has the opportunity to provide feedback to the house on that clause within the bill and perhaps why that has been specifically outlined as being ‘one nurse’ rather than being ‘one nurse or one midwife’ that would be greatly appreciated. I know the member for Sandringham would appreciate that feedback, as would his constituent, who is deeply concerned about the way the current bill is outlined and that midwives may be subordinate to nurses within the workplace. Again, I do not think this is a deliberate attempt, but I do seek some feedback from the minister regarding that.

While we do have a number of areas of concern, I think the key point really goes to how we support our fabulous health professionals to deliver the best possible patient care in a hospital environment, but also out in the community. Again I refer back to patient safety. I think if there is one lesson learned today and over this week, it is how important it is that we respect the privacy and confidentiality of patients. Whether you are a mental health patient, whether you are an inpatient of a hospital or whether you are in the community environment, if you have had the courage to have a discussion — and particularly around mental health — you should have every confidence that information will be kept private and confidential. For this to be breached by the government I think is a gross violation of the foundations to provide safe patient care in the state of Victoria. I do not know how that can be fixed, and I do not know how the violations of patient confidentiality —

Ms Williams — On a point of order, Deputy Speaker, I was pleased for the brief time that the member for Lowan did address the substance of the bill to see her doing so, and I think the conduct in the house reflected that: people listened respectfully. But yet again, and I suspect it is because she has not done any research on this bill and therefore is struggling to fill 30 minutes on the substance of the bill, I would ask you to reprimand the member for Lowan for straying from the content of the bill onto, again, an unrelated matter. Please direct the member for Lowan to redirect her remarks to the content of the bill so that the conduct in this chamber can again return to being respectful in listening to her. At the moment she is straying into very disrespectful territory on a very important bill.

The DEPUTY SPEAKER — Member for Lowan, I do ask you to speak on the bill. I have given you some latitude.

Ms KEALY — I will pick up on some elements of that point of order. I have worked in many, many hospitals right across Australia, and I have worked closely with nurses and I have enormous respect for nurses. As I have said, I respect nurses because I know the lengths they go to to protect health privacy and confidentiality, and I stand by each and every one of my comments. That is entirely respectful for nurses because they go to such great lengths to keep our information private. They take such great steps to keep that information private and confidential, often under extremely difficult circumstances, where it might be someone who is a friend or a family member of somebody they know. The respect that they have for privacy and confidentiality is something that must be respected by the government of the day. It is grossly disrespectful to think that the information that nurses have gone to extreme lengths to keep private can then be just printed publicly by the government of the day for anybody to see. That is a gross violation of every single nurse —

Mr Foley — On a point of order, Deputy Speaker, the honourable member for Lowan has not taken up the opportunity that you have respectfully given her to address the substance of the bill, and I find myself in support of the earlier points of order made by the honourable member for Dandenong. Whilst we all admire the health contributions that the honourable member for Lowan has made in her career, can we perhaps bring the honourable member back to the bill. If the honourable member wants to continue to take issue with the points of order, then she had the opportunity to do so; she did not. I would ask that you bring her back to the substance of the bill, rather than this merry‑go‑round that she seems intent on pursuing.

Ms KEALY — On the point of order, Deputy Speaker, I pick up the comments by the Minister for Mental Health. I am quite surprised that he is defending some of the actions of his government in me speaking about how important patient privacy and confidentiality is to provide safe patient care. Again I go back to the minister’s second‑reading speech, where it quite clearly outlines the community values and expectations of the health sector in Victoria.

This is core to what I am speaking to. I believe that my experience in the health sector, which I was referring to, and my great respect for the time and the commitment that nurses make to uphold that backbone of health, which is key to the ethical commitment to keep certain information private and confidential, should be upheld.

The DEPUTY SPEAKER — Member for Lowan, you have a very short time left, and I have given you a lot of latitude. I ask you to return to the bill.

Ms KEALY — I do go back to some of those issues that I have raised. I ask the minister to ensure that this legislation is appropriately funded, that hospitals are provided with the full details of the budget, and when that money will flow to ensure that they can make sure they can continue to provide the best possible patient care by supporting their nursing and midwifery workforces, which they do very, very well. I do again uphold the great work of nurses and midwives and the work that they do in the state of Victoria. There are other issues around the special care nurseries, and I trust that the minister will provide some feedback around them, but in particular we need to make sure that anything we do around health care provides the greatest benefit to patient care in the state of Victoria.