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Health Agriculture | November 30, 2017

Health And Child Wellbeing Legislation Amendment Bill 2017 - Second reading part two

Debate resumed from 16 November; motion of Ms HENNESSY (Minister for Health).

Victorian Parliament - 30 November 2017 - Ms KEALY  - It is a privilege to speak today on the Health and Child Wellbeing Legislation Amendment Bill 2017. This is a broad‑ranging bill that focuses on four main elements that the government is seeking to address, which are issues that have come up over the last two years. The first element is to tighten immunisation evidence requirements under no jab, no play; the second is to establish mandatory reporting for cases of anaphylaxis in hospitals; the third is to clarify provisions relating to the reporting of allegations of child abuse, sexual misconduct and other child‑related misconduct; and the last is to place under statute the power of the health complaints commissioner to prosecute.

I would firstly like to speak to the first element of the bill, which is around the no jab, no play policy of this government and the associated legislation. This amendment is in relation to an issue that arose in August this year when Dr John Piesse said that he could help anti‑vaccination parents sidestep the no jab, no play laws by providing evidence that a child was unable to be vaccinated for medical reasons. To date there have been 42 cases identified where this type of evidence has been provided, perhaps not necessarily based on medical fact, for parents to avoid their children being vaccinated.

The issue of no jab, no play has been controversial in some parts of the community. I think that most people understand the importance of herd immunity. If we have a critical number of people within the community immunised, that will provide greater immunisation for the entire population so that those few people within the community who have a medical reason why they cannot have a vaccination are actually covered because all other people within the population are vaccinated. It could be a virus, which in most instances is what this issue is applicable to, that is not communicable between different individuals who are not vaccinated. Unfortunately we have seen a number of reported cases of measles in pockets of the state recently. This is because if we do not have that herd immunity the virus can easily move from one individual to another individual who is not vaccinated. This is a particularly dangerous situation for people who are immunocompromised: our elderly, people who have an immune disease and people who cannot for medical reasons have vaccinations.

I understand that there are some people in the community who are deeply concerned about the impact of vaccinations on childhood development and what vaccination may result in for their children. This is sometimes on the back of very misleading and false information which has been circulated by some high‑profile celebrities and doctors, who have sought to spread misinformation about the implications of vaccination. Most notably this has been be a false association between vaccination and autism. This is something that has been absolutely disproved by the medical fraternity, that there is an association between autism and vaccination. However, because the information has been distributed to the wider community, it is still believed by some that this could be the case.

There are also stories that this is around supporting the pharmaceutical companies, so it is all about big pharma and getting money through to pharmaceutical companies. This certainly is not the case in Australia. I think that is based on situations within the American system, but again I do not believe that it is fact. In Australia there are certainly not those opportunities to get money through to big pharma so that they may support, I guess, government bodies or political parties in certain ways. We do not see that. There are rules and laws against that in Australia, and I do not believe that that is the case, having worked within the health system for all of my career prior to entering Parliament.

It is deeply concerning that the trigger for this amendment to legislation has come about because of a doctor who seemingly has the intention to provide misleading medical certificates that are not based in medical fact to offer parents who do not want their children to be vaccinated an opportunity to use a loophole and not have their children vaccinated. It is disturbing that a doctor would use his position to intentionally target people and market himself as somebody who can work through a loophole in order to get people to come and see him. I think that it is a disgrace upon the medical profession that somebody would operate in that manner and certainly a disgrace to think that a doctor who had undertaken years of medical training would be willing to provide false or misleading medical reports in order to get patients through the door and therefore money into his pocket. This is the sort of individual that we do not need to see in the medical fraternity. It brings a bad name upon everybody. I think that he should be dealt with in the most severe way and that he certainly should not be practising as a doctor any longer.

It is important that we do close some of those loopholes, but unfortunately this legislation does not address many other loopholes that are available for exemptions to vaccination. If the government was serious about closing those loopholes, we would certainly see a much broader array of amendments being put forward in this bill. I think it is disappointing to see that we have targeted only one area, one loophole, because it came through the media that it was an issue, as opposed to addressing some of the other loopholes which were identified when the no jab, no play legislation was brought in in 2015 and came through Parliament in 2016.

For example, there are exemptions around Aboriginal and Torres Strait Islander children being vaccinated. There are also exemptions in place for children who are in the care of concession card holders. That represents about 7000 children in Victoria. We are not talking about small numbers and there being only a small pocket of individuals. If the government’s intention is to achieve herd immunity in the community, we need to get the largest possible number of Victorians immunised and we need to close off those loopholes. I would have preferred that this legislation dealt with those loopholes in a much broader sense. However, it is pleasing that at least one of the loopholes may be closed should this legislation pass.

We also do not have an understanding of how effective the no jab, no play policy has been. Unfortunately there is not any data available in relation to the number of exemptions that have been provided within Victoria under the no jab, no play laws. This is something that I think should be addressed. I acknowledge that it is extremely difficult to do so because generally that information is held by the individual centres as opposed to coming through to a central data point such as the department of health. That would be the most likely body that should be the end point of the collection of that data, but generally it is held at a local centre level.

If we are going to measure the success of the no jab, no play legislation and this policy, we really need to get an understanding of whether we are achieving herd immunity. I know that we do receive some statistics about immunisation rates, but we also need to make sure that we understand what are the trends in terms of exemptions. That might provide us with the additional information we need to see if there is a pocket or a section of the state where there is a higher number of exemptions being issued than in other areas of the state. Therefore we could identify if there are any doctors who are intentionally marketing the fact that they will provide a medical exemption for vaccination of children in the same way that Dr Piesse has been found to have worked around that loophole and created a business around that.

Access to data is exceptionally important around reporting but also for transparency and understanding in the community. People who live in an area where there may be a high number of exemptions which therefore results in lack of herd immunity need to be aware of the community that they are living in. Where possible we can give some information to individuals so that, if they are immunocompromised and if there is an outbreak of a certain disease in a region, they can avoid it. This is important information, and I think it is the responsibility of government to ensure that we have accountability for policy and also that we provide as much information as possible to Victorians.

I would like to now move on to the section of the bill in relation to mandatory reporting of cases of anaphylaxis in hospitals. This amendment to the legislation came about after the very sad story of Ronak Warty, who died from anaphylaxis after consuming a mislabelled beverage bought from an Asian supermarket in Burwood East. Through the coronial inquiry it was found that his parents took every step to ensure that their lovely son Ronak was not exposed to dairy products. He had an exceptional allergy to dairy products. They purchased the coconut milk in good faith. Unfortunately the imported product was not labelled correctly. It was not labelled that it contained cow’s milk and the anaphylactic shock that this young man went into unfortunately contributed to his untimely death. I do issue my sincere and heartfelt condolences to the Warty family. It must be absolutely heartbreaking to lose a child. It is something that I cannot imagine, but as the mother of a four‑year‑old I feel nothing but their pain — to think that they went to every effort to protect their son but due to labelling on a food product that they checked but was mislabelled they now will not have the joy of seeing their young man grow, thrive and be successful. It is a terribly sad story.

Most sadly, it took so long for the government to react and to recall that product through the framework which is currently in place. It in fact took six weeks for the mislabelled beverage to be recalled. It was too long, and in some ways it is a surprise — but a very good thing — that nobody else was involved in a significant allergic reaction during that period of time, or at least there were no reactions that the public have been made aware of.

The coroner did an inquest into this case. A mandatory reporting system was recommended for children presenting to Victorian hospitals and emergency departments with anaphylaxis. Within this bill there is a requirement for hospitals to report cases of anaphylaxis to the secretary of the department. I would like to refer to the coronial investigation and report, because there are a number of recommendations included within this report. First, of course, is ensuring that the Department of Health and Human Services (DHHS) secretary investigate, consult widely and formulate a program for mandatory reporting for children who present to hospitals and emergency departments with anaphylaxis.

The second recommendation is for the DHHS secretary to incorporate into the process of formulating the mandatory reporting program interrogation of the sources of anaphylaxis whereby if, as in Ronak’s case, it becomes apparent that a contributing factor involves a packaged foodstuff or labelling of a packaged foodstuff, the report can be directly referred to the department’s food safety unit.

To impose this mandatory reporting upon hospitals is exceptionally difficult, and I think that that was noted within the minister’s contribution to this report. Through the reporting system that hospitals all use there may not be an opportunity for hospitals to report whether a foodstuff was believed to be the trigger for the allergic reaction and anaphylaxis. It is something that would be unlikely to be under investigation or to be known at that point when the report is made through the hospital reporting system. So I can certainly understand the coroner’s recommendation that there be a link to the food safety unit and that foodstuffs be identified wherever possible. However, it does not appear that this is addressed within the legislation. I acknowledge that it may not be the most appropriate place for relationships to the food safety unit to be included. However, I do urge the minister and the government to ensure that there is a strong linkage in the implementation of this legislation, should it pass, so that there is a secondary investigation into reports where there is anaphylaxis or an allergic reaction and suspicion a food product may be involved, so that we can rapidly recall products.

It is difficult to ensure that we have enough information and enough data reported so that we can scrutinise it to save a life, but it is also difficult to ensure that all of that data is reviewed in a timely manner and action is taken, which in this instance would be the recall of a food product that has been mislabelled and which may potentially save a life. We also need to balance that, though, with responsibility for the incredible amount of additional data and reporting that is put upon our health services with sometimes limited feedback to the bodies. I recall as CEO of Edenhope hospital the sheer amount of additional reporting that we would have to provide and the limited amount of feedback that that would result in to improve the services that we were delivering to the local community.

If the government is imposing additional administrative burden or additional responsibility upon the hospitals, I would urge the government to provide additional funding for hospitals as well. Unfortunately, as the administrative burden increases on our healthcare services, more money has to be put into administration and there is simply less money available for services to buy new pieces of equipment, to provide that paint job to make sure the facility looks of a standard suitable to patients coming through or to make sure they can keep on top of minor building works and maintaining their assets. So I would urge the government to take into account that this will put an additional administrative burden on our healthcare services and that perhaps it should consider providing some additional funding to our hospitals to make sure that services, particularly in rural areas where there is a much smaller administrative unit, can continue and we do not just end up with a hospital full of administration staff and no patients. I think there might be a Yes Minister episode dedicated to that most efficient hospital, which was all managers and where no patients came through the doors.

We do need to take into account as well that this will rely very heavily in a practical sense on human beings, the fantastic staff within our health services, to remember to report these types of instances. It will be something that I think will have to come through looking at a medical review of all cases of anaphylaxis that present within hospitals. That may be occurring in any case, but it will require an amendment and will, again, add additional administrative burden to our health services. I would like to also ensure that we have full coverage of all of the different health services within Victoria. I know under new section 130A, ‘Definitions’, that:

anaphylaxis reporting body means—

(a)   a public hospital; or

(b)   a denominational hospital; or

(c)   a private hospital; or

(d)   a multi purpose service; or

(e)   a privately‑operated hospital within the meaning of the Health Services Act 1988 …

Just from my perspective, I have three fabulous bush nursing centres in my electorate, at Lake Bolac, Dartmoor and Harrow. They do an absolutely fabulous job. They are legitimate health services that have nurses on site, sometimes nurse practitioners and often visiting GPs. If somebody presented to a bush nursing centre under this legislation, there would not be mandatory reporting. In some instances, such as, obviously, if somebody is in anaphylaxis, it may be of such significance — and it is a significant event — that it is likely that person would be referred on to a hospital setting. However, that may not occur in all instances. Just for completeness of the bill, it may be worthwhile including bush nursing centres within that listing to ensure that no anaphylaxis case is missed within the state of Victoria.

I would now like to move on to the third element of the bill, which is around clarifying provisions relating to the reporting of allegations of child abuse, sexual misconduct and other child‑related misconduct. This is really around the reportable conduct scheme for the child safe standards. There have been conflicting interpretations of some provisions within the statute, and this bill makes three principal changes. The first one is clarification that foster carers and kinship carers will be considered employees of the entity which appointed them; however, this does not create an employment relationship between the parties.

Just on that point, I would like to make special note of the foster carers and kinship carers right across the state. They are poorly funded. They do an incredible job. They pick up children who are in need at sometimes very, very short notice, and they do this really for the reward and love of what they do and to ensure that some of our most vulnerable children actually find a home for a period of time and are safe, nourished and loved and cared for. I thank every foster carer and kinship carer around the state. They do an absolutely amazing job. But we need to make sure that we clarify that relationship and that anyone who is not doing the right thing is picked up and removed from that program. For the most part our foster carers and kinship carers do an absolutely outstanding job, and I thank them for that.

The second element of the proposed section clarifies the definition of the head of an entity, who is required to report under the scheme. This is quite sensible. We need to ensure whose responsibility it is to make a mandatory report so that there is not confusion and so that the report actually does occur. We need to ensure that there is not an out for an entity that has not done the right thing and made a report when it should have. This element of the bill also allows for increased information sharing. Again, it is very important that if we know there is someone not doing the right thing, we can share that information so that other organisations and agencies and the children within that system are protected.

The final element of the bill relates to the health complaints commissioner. Recently the health complaints commissioner, Karen Cusack, raised concerns about her power to prosecute under the Health Complaints Act 2016, including the lack of a specific provision in the statute that would cause unnecessary delay in prosecution if the common‑law power of the commissioner were challenged. This bill essentially places that power into the statute. It seems like an eminently sensible move. However, again, if this requires additional work to be undertaken by the health complaints commissioner, I would urge the minister to provide additional resources for the health complaints commissioner so that a backlog of complaints is not created, she is able to undertake her position as commissioner effectively and, if she has the power to prosecute, she has the resources at her fingertips to enable her to do so.

This bill does have wide support. We will not oppose the bill in the Legislative Assembly, but I would like to just make note of a few other elements. Something that has come through in my research for my contribution today has been around the need for hospitals to have the funding they need to deliver the services that the community relies on.

I recently was privileged to be the number one ticketholder for the Great Wimmera River Duck Race. This event was run last weekend, with all 2000 ducks sold at five bucks a head. It was a fantastic and very competitive race. The wind was challenging at times and it took the ducks from one side of the river to the other, but they did a fantastic job. As a result the friends of the Wimmera Health Care Group Foundation raised about $9000 for the Wimmera cancer centre, which is an outstanding achievement for a committed group of volunteers. They do an absolutely fantastic job, and I thank each and every one of the friends of the foundation committee for their efforts in continuing to raise great money for our local hospitals.

We have got ladies auxiliaries or hospital auxiliaries right across the region, and they put a tireless amount of work in to raise money for our hospitals so that they can purchase things like televisions and more comfortable seating. I know at Edenhope and District Memorial Hospital our hospital auxiliary raised a lot of money to actually build a hairdressers salon on site so that our elderly residents in aged care could get their hair done nicely and feel like they were actually having an outing. They did not even have to leave their building to feel like they were being pampered. This salon has made an enormous difference to their lives. I thank all of the hospital fundraising bodies across the electorate.

We do need to see more funding for our hospitals. Unfortunately most of our hospitals, in particular the Hamilton Base Hospital, have received little, if any, capital funding over the past three years under the Andrews Labor government. The coalition had an election commitment to provide a significant amount of capital money so they could provide an upgrade to their emergency department (ED) and intensive care unit (ICU). We have not seen the government interested in this at all. It is exceptionally disappointing for the Hamilton community that the people at the hospital have had to make do with a reconfiguration of their ED and ICU, facilities that are simply outdated and desperately in need of an injection of funds. That would certainly help the valuable medical, clinical, nursing and administrative staff that work at Hamilton hospital. It would help them to do their job. It would make sure that local people have access to the best possible health services, and of course that is what country people deserve. They deserve to have access to the highest quality health services, the same level that a similar hospital would provide if you lived in Melbourne.

Another element of course around healthcare outcomes in our region is access to public transport. Yesterday I heard the story of somebody who had to travel over 7000 kilometres over the duration of their cancer treatment because they were going back and forth to Ballarat. This is simply not good enough. It is incredibly difficult for people to use public transport in that area. Unfortunately under the Andrews Labor government we have seen numerous cuts to services. We have seen the ridiculous changes to schedules so that we now have longer travel times to our part of the state. We have lost services to sections of our state. Something that is being sold as an additional service might involve a bus and a train leaving at exactly the same time from Melbourne. That is not an additional service; it is a cut.

We need to have better access to public transport in our region. It would mean that people who cannot drive, particularly where there is not access to other transport options like a taxi or even a community vehicle, would be able to get to the health care that they need. I know firsthand that people are not accessing health treatment, seeing a GP or even getting their pharmaceutical supplies simply because they cannot get to a medical service, so I urge the government to look at a whole‑of‑health strategy that is beyond the changes that are included in this bill. We actually need to make sure that people can get to healthcare services as well as delivering high‑level services right across the state.

In summary, there are elements of this bill which we think are eminently sensible. It is not a major bill in terms of the changes that are being made. It is making a number of amendments that should improve the overall system. The only concern that I really have is around some of the loopholes. There was further action to close loopholes around the no jab, no play policy to ensure there is greater herd immunity within the state of Victoria, which particularly looked at closing some of those loopholes around the 70 000 Victorian children who are currently eligible for legitimate exemptions. We need to make sure that we have adequate data reported in a public way to understand exactly how many people have been given an exemption under the no jab, no play requirements. We also need to make sure that we sufficiently fund our hospitals so that where there is an additional administrative burden there is no risk at all that health services will be cut.

I would like to thank everybody involved in the health sector in my electorate; they do an absolutely fantastic job. I urge everybody to take care of their health needs and to make sure that they see a doctor and if they think something is not right, that they follow that up. I know it is exceptionally difficult to get in to see a doctor at the moment; we have had a huge number of GPs leave the area. But please persist; make sure you sort out and deal with the issues that are presenting. It will mean that you are available for your family in the future and it will mean that you will be a much healthier and more productive person. Hopefully you will enjoy a much longer life if you look after your health needs first.