Second Reading - Safe patient care (nurse to patient and midwife to patient ratios)
Victorian Parliament - 5 February 2019 - Ms KEALY (Lowan) (16:32:26): It is a great privilege to be able to speak on this bill, although I think it is an adjustment for all of us to get back into the rhythm of speaking on bills and providing debate. I know we are all making a fantastic effort, and it is great to be within this 59th Parliament and to be able to represent our constituents and the people of Victoria to put forward our views on important legislation and make sure that it meets the needs of our local communities. This is of course the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2018. It was introduced late last year, and it is a bill that was debated in the 58th Parliament but failed to pass Parliament at that time due to the late stage it was brought to the house. I would like to take some latitude, given we are talking about safe patient care and particularly talking about midwives, to make mention of three special patients who are in the Wimmera Health Care Group hospital today: my lovely friend, the sister of my partner, Ange, gave birth to two big boys this morning just before 8.30, and so I congratulate Ange and Nathan and their two little boys and welcome them into the world. I know that they will be receiving fantastic care from the lovely nurses and midwives in Horsham at the Wimmera Health Care Group, so I just wanted to take some latitude to be able to mention that, because it makes us all glow a little bit when we know little people are coming into the world that we care about. In regard to this bill, the purpose of the bill is to require nurse-patient ratios to be rounded up where the number of nurses required is not a whole number and to specify a method to apply rounding when calculating the ratio of a mixed ward. It is to limit the hospital’s flexibility when applying ratios to allow both nurses and midwives to staff special care nurseries and postnatal wards for the purpose of meeting the ratio, to introduce new ratios for oncology, acute stroke and haematology wards where previously general medical ward ratios would have applied and to improve the ratio in emergency departments, special care nurseries, palliative care wards and birthing suites. As I mentioned in my opening words, this is a bill which has had some amendments but is heavily based upon a bill which had a journey through the 58th Parliament of Victoria. Prior to the 2014 election Labor promised to enshrine nurse-patient ratios into legislation and to consider improvements to the ratio, and there was a task force which was developed over time. They provided some consultation into what should be amended and how the ratios should be presented, and it is my understanding that while the final recommendations of this task force are not public, the amendments were informed by their recommendations, but in some instances they slightly differ from those recommendations. One of the key issues that was raised in the last form of legislation, the last version of this bill that came through the 58th Parliament, was in regard to elements of then section 27, where there was an element where nurses were referred to in a clause. However, midwives were not referred to within that clause. I must commend the former member for Sandringham, Murray Thompson, for his strong advocacy around changes to that specific element of the bill. There was also a lot of advocacy from the Australian College of Midwives. All had the concern that by not including midwives in this specific clause of the bill, it did appear, because ratios would be based upon nurse numbers rather than nurse and midwife numbers, that midwives were going to be seen as subordinate to nurses because they had not gone through that qualification process where they were not a nurse and a midwife. We understood that that was not the intent of the bill, but we did outline some concerns around that and encourage the minister at the time to make those amendments. It was something that was of deep concern to a number of nurses and midwives right across the state. It is something that was highlighted through correspondence with the minister, not just by me and other members of Parliament, but as I said there were also advocacy groups and unions who were contacting the minister as well to advocate for this important change to the legislation. This was well-known prior to the bill being debated in the Assembly and of course would have been well-known before debate in the Council because it was tabled during debate in the Assembly at the time. There was limited time to be able to debate this legislation, as I recall. It was the second-to-last week of the 58th Parliament. It was brought on on the Thursday, the last sitting day of that week, with only 1 hour to spare for the debate. I know that there were a number of members who wished to speak on this bill but they were not afforded the opportunity to do so. We flagged at the time that the bill was flawed, that we needed to see some amendments in there before it could be passed, and unfortunately those amendments were unable to be implemented because, when the bill had its journey through to the Legislative Council, again there was significant delay in tabling the bill for debate. In fact it was left until the Thursday of the final sitting week, the final sitting day, the final sitting session, with half an hour to go on that day, when the bill was brought to debate. This is simply not enough time for a true debate, and of course there was not the ability at that time to extend the sitting hours—the upper house voted on that and the hours were not extended. But while there has been some commentary that this was about filibustering or about intentional delay of important legislation around nurse-to-patient ratios, this could not be further from the truth. You cannot possibly filibuster when you have only been afforded a total of 1½ hours between the Legislative Assembly and the Legislative Council. In important bills with regard to improving patient care, I think we should ensure that there is an appropriate amount of time to debate these bills because we can determine other faults in clauses and gaps within the legislation which we should afford the opportunity for Parliament to fix and ensure that it is right. I would like to think that in the heat of the lead-up to the election this was not done intentionally as a political ploy. I think it would be disastrous if that were the case, if we were actually playing with patients’ lives in order to get a couple of political points, and of course now we have come to the point where we will see a delay in the implementation of the nurse-to-patient ratios and midwife-to-patient ratios because the bill was not handled as a priority at the end of the 58th Parliament of Victoria. We do need to make sure that that is on the record because, as I said, there has been some misinformation circulated around the passage of the bill. Certainly I think in the limited time that the Liberal and National party members of Parliament had to contribute to the debate on the bill very sensible amendments were put forward and very sensible and thoughtful concerns were tabled, but also there was generalised support, which there should be for our fantastic nurses and midwives, who work all throughout the day and night to support us at our most vulnerable times. We are very, very fortunate in Victoria that when we need it, if we have to go to hospital, we can rely on a system that will be available to us. We know that we will have well-trained and qualified staff looking after us and that we will receive care which is equivalent to the best in the world. We really do need to take the time to thank all of the staff within our hospital network in Victoria. I had the great fortune to work within the health system for most of my career before I entered politics, and I have seen firsthand the amazing work that health service staff do each and every day. It always astounded me how staff would go above and beyond just what their position description would be with the utmost priority being caring for patients. That is not just about physical care, about making sure that wounds are treated and medication is given appropriately and accurately and about being aware of and sensitive to a patient’s and emotional and physical wellbeing and needs. It is also about the little things that you see caring staff deliver to patients in Victorian hospitals. It is the little things like understanding that they might have a favourite blanket that they like to use or that they might like to know that something is happening in the community and people will keep them informed and make sure that they feel included and not isolated from what is going on in the rest of the world and that they do feel safe. So I do give utmost credit to our nurses and our midwives in the local community. I would like to reference one of my favourite nurses and midwives, and that would be my midwife, Sarah, who I did acknowledge in my last contribution to the previous bill in the previous Parliament. Sarah was an absolutely amazing support to me in the delivery of my little boy, Harvey, and I will never forget the support that she was able to provide throughout my pregnancy and through the delivery as well. It was absolutely outstanding. There are still some concerns that we have in relation to the implementation of this legislation, in particular in relation to how it will be rolled out and the costings to ensure that hospitals are given appropriate amounts of information and funding and time lines to be able to manage this in an appropriate way and a safe way. We know that particularly in rural and regional areas it is a very small variation in budget that they have to manage, and a small fluctuation in salaries and wages, whether that be up or down, can really change the final figure on the bottom line of the budget papers or the profit and loss. So while there has been some mention of some funding support for implementation of this bill, I am not certain that it will go far enough. Hospitals still have not been informed when that funding will flow. It will take some time to fill vacant nursing positions to be able to deliver on the increased ratios, and that delay in the time frame puts at risk some of the services that we are able to deliver, particularly in rural and regional hospitals. We need that information to flow sooner rather than later, and this is a conversation that I have had with a number of my local CEOs in the Lowan electorate. We need to make sure that there is some certainty about that. So I do urge the minister to provide that relevant information to hospitals sooner rather than later: how much funding will be provided, when that funding will be delivered and also a plan about how those positions and vacancies will be filled sooner rather than later. It will compound a really serious issue we have got within the health sector—that is, we simply find it very, very difficult to fill our vacancies, particularly in rural and regional Victoria. We have a health workforce crisis. We have not got a health workforce plan in Victoria. It is something that the Liberals and Nationals committed to during the 2018 election campaign and which was heavily supported by the Victorian Healthcare Association. If we look at what we are currently delivering in terms of health care, we have not got sufficient health professionals to be able to deliver it. When we look at changes, whether it be changes to nurse-to-patient ratios or whether it just be about changes in how we deliver health care, about the type of procedures that we will be delivering into the future and adapting to the ever-changing framework of best practice in health care, we need to make sure that today we are training enough people to fill all of the positions that we will need in the future and make sure that every Victorian, no matter where they live, is able to access the health care that they deserve and that they need. We have got a crisis in rural and regional hospitals at the moment. You cannot recruit enough nurses, doctors or any sort of allied health professional. There has been a concern raised with me by CEOs and other leaders in health that implementation of this legislation, by increasing ratios, will actually create a drain on the health workforce and nursing workforce in rural and regional areas f course there will be an increased number of positions in metropolitan areas. Sometimes they have more leniency and a greater ability to provide a bit more money to attract people to come. It is an incredibly difficult task that you have in rural and regional areas to attract and retain staff now there are more and more jobs out there. Having not trained more staff and more nurses today, we are going to see a huge chasm open. There will be a push then to recruit agency nurses or bring in locums, which has a huge additional cost burden. I would like to ensure the minister is aware of this cost burden that will hit our rural and regional hospitals. She needs to be aware of that so that she can fight for additional funding when it comes to the next budget to make sure that we do actually have a huge increase in funding for our rural and regional hospitals so they are able to deliver on the increased work and increased money it is going to cost them to staff their hospitals until we have sufficient numbers of trained nurses and midwives to fill these vacancies across the state. It is something that I do ask the minister to take a serious interest in because of course hospitals have limited budgets. If they cannot afford staff, it puts services at risk. You have to balance the books, so if it is costing too much to deliver a patient care service, something that someone in a local community relies on to keep well, then you will lose staff and you will also lose local access to important healthcare services. That in turn will push up patient travel and have an additional cost burden on the state budget. I ask the Minister for Health and the Treasurer to take this very, very seriously because even a small support fund that is put in place across the state, come 1 July, is simply not going to go far enough for those flow-on costs to hospitals when this legislation takes effect. This is something that is of huge concern across our hospitals, so I would seek again that the minister reassure our healthcare leaders that the government have a plan around how they are going to deliver this and ensure that our hospitals across the state, whether metropolitan or rural and regional, are not put at financial risk. Just in summary, they are our key concerns. We are obviously extraordinarily pleased that the elements around section 27 have been addressed and specifically that the government has listened to the concerns of the Liberal-Nationals, the concerns that were raised with the minister prior to the bill being introduced. The concerns that were raised by me during my lead speech were also raised in the upper house by the former shadow Minister for Health. I am very, very pleased to see that the two remaining important matters that needed to be addressed regarding funding and training support for nurses have been addressed. Of course we need to see Labor follow the lead of the Liberal-Nationals and listen to the health sector and undertake a health workforce plan to ensure we have sufficient health professionals trained and recruited to deliver the health needs of our local communities. Again, I thank all nurses and midwives for their great work and commitment in providing outstanding care for all patients in Victoria.
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