Health Legislation Amendment and Repeal Bill
Victorian Parliament - September 12, 2019
Ms KEALY (Lowan) (10:18:10): It is fantastic to have the opportunity to speak on this bill, the Health Legislation Amendment and Repeal Bill 2019, on behalf of the Liberal-Nationals coalition. At the outset I will give a brief overview of the bill, but then there are further elements that I would like to dig down into and raise some further concern around, particularly in relation to mental health in relation to the information-sharing parameters, but also about the wider importance of quality and safety and how we communicate the issues around mental health into our wider community and across agencies and to health organisations, particularly in rural and regional Victoria. This bill is an omnibus bill. It covers four main areas, which are around further restriction of tobacco advertising, information-sharing between health services, repeal of the Access to Medicinal Cannabis Act 2016, and other miscellaneous amendments which include but are not limited to a change of the role of the mental health complaints commissioner to align with the health complaints commissioner. I will deal with those four areas individually and work through other areas of concern as we flow through the debate. The first element is around e-cigarettes. The rise of e-cigarette products and the heavily regulated nature of the tobacco industry has seen big tobacco look at other industries to share the load of their business and to ensure they have got a future business model that can relate to people. At the recent Australian Formula One Grand Prix in Victoria we actually saw the introduction of the advertising of e-cigarettes where it was not done by words or language, which could have been picked up by current legislation; it was an image of an e-cigarette instead. While there is current legislation and regulation around the advertising of e-cigarettes, the department has found that it is not significant enough to be able to manage all of the different ways that you can brand a product. Therefore this part of the legislation is around broadening those parameters so that it is not an individual event, such as what happened at the Formula One Grand Prix in Melbourne, in that you bring in a ban for just one event; it is much broader than that to provide greater teeth to the government. Obviously we want to make sure that if there are these parameters, any time there is an increase in regulation or legislation around restricting advertising or restricting certain activity we do need to make sure that that is properly managed, maintained and monitored. So while I understand there is an initiative to do that, the current legislation does not go quite far enough—it nearly catches it, but not quite—but this will make it easier. It is also important that we do make sure that it is properly adhered to and monitored in the community. The second element of the bill refers to the repeal of the Access to Medicinal Cannabis Act 2016. This is really largely around federal legislation, which has now been passed and has made the Access to Medicinal Cannabis Act in Victoria redundant. There is no suggestion of there being a deficiency or any loss of mechanism in the state of Victoria if that act is repealed. We now of course have access to medicinal cannabis in the community. I know that there were a lot of stories throughout the trial of medicinal cannabis when it was outside of our legislative framework. Speaking to some of those families you can see the difference that having access to medicinal cannabis makes. We need to make sure, though, that we do have good guidelines around that. We need to make sure that we do not develop a black market around medicinal cannabis, which may already be in existence. We also need to make sure that it is not abused by people who should not be using the product. We also need to make sure that we properly manage the cultivation of medicinal cannabis. Obviously there have been some announcements around that in the recent past, but we need to make sure there is effective security around those facilities to ensure that they are not unnecessarily and unfairly targeted for attack in a positive or negative way—theft of property or damage to property. And we need to make sure that all of this investment is done in regional Victoria. Too often we see industries such as this one, which should be in regional Victoria, developed in inner city areas or in regional cities. It is an opportunity where we can really look at embracing what happens in our regional communities, which is good. We grow really great produce. So I do encourage further expansion of that but also looking at doing that in rural areas of Victoria. If I do not put in a plug for my fantastic area of Lowan in western Victoria, one-sixth of the state, where we have a prime growing region, then I think I would be remiss in not flying the flag for my region. I would now like to go to the information sharing element of this bill. When we received the briefing around this bill the focus really was that the community has a right to know, and I absolutely support that position—that the community has a right to know. It also breaks down some of those issues in relation to the sharing of information where some health organisations thought they might be in breach of the Privacy and Data Protection Act 2014 if they were to share information, particularly around serious or sentinel events or other things that have gone wrong in a health service that should be reported. There are some issues around information sharing. Really, again, it comes back to an issue I raised earlier, which is about making sure that if we are doing something we are effectively monitoring it and effectively making sure that people who do the wrong thing are penalised and removed from the system. That has to be emphasised when it comes to health care. Too many times we have seen health providers doing the wrong thing and not being quickly enough dealt with or not having their registration removed. There appears to have been a leniency towards protecting health professionals in their practice and their right to earn an income, sometimes at the cost of further damage and wrongdoing by that medical practitioner, which has caused great harm to the community. That is not acceptable. I think at this point in time we see some organisations being particularly toothless when it comes down to making sure there are quick and efficient outcomes for complaints against health professionals when they are doing the wrong thing. There are cases where it is absolutely clear. We should not have those sorts of cases going on for years and years and years while those health professionals are still treating and seeing patients. Often it is dangerous for them to do so. So while I understand the imperative of this bill, I do not know whether the government has put in place effective organisational structures to swiftly deal with health professionals when they are doing the wrong thing. That is much more important, in my view, than trying to pin it back to, 'The problem is information sharing. No-one’s sharing information’. I think it is much broader than that. Even if information is shared, we do not see that quick response that the Victorian community deserves when it comes to thinking they are going to see a doctor. They see the word 'Dr’ before the doctor’s name and they trust that they should be able to do the right thing and receive high-quality health outcomes. So while I understand the rationale behind the information sharing, let us make sure that we have got effective penalties in place and also a reactive system, a very strong system, that can get out the bad guys as soon as it possibly can to avoid damage to Victorians. There are a lot of limitations when it comes to information sharing, though. I raised this during the bill briefing. It was vocalised very strongly during the briefing that people have a right to know about the quality and safety of their healthcare provider. I absolutely agree with that, which is why I think this bill really falls short when it comes to encompassing all health organisations in Victoria. For example, I find it quite amazing that community health centres are not included in this bill. Community health centres offer a range of sometimes invasive health procedures, dentistry for example. They have a real importance I think, and that same consistent requirement is given as a reason that hospitals or small private small-procedure units or any of those other health organisations are included in the bill. Why aren’t community health centres also included? There is of course also the other element to this, which is the injecting room in North Richmond—something that is obviously quite controversial. There is more and more debate about that, particularly around the impact that it has had on the local community in Richmond. The community is clearly angry about the impact that that injecting room is having on the local area. We are seeing more crime, we are seeing more ambulance call-outs, we are seeing more overdoses on the streets and we are seeing injecting right in front of a primary school. The residents are stressed. They do not know what to do. While there has always been an issue with drugs in that Richmond area, they have seen how this injecting room has created a honey pot effect of centralising a lot of drug use. Because the access is so simple and because the police have to turn a blind eye to any of those activities in the local region, the community is really left prone to the activities that are going on at the moment. I see that there was some information leaked to the Herald Sun late last night concerning the statistics around the injecting room. Time and time again the community have been asking, I have been asking, the entire coalition has been asking: what are the key stats around this centre? What are the outcomes? Is it actually making a difference? Do more people have a roof over their head after they have been through the injecting room? Are they getting a job afterwards? Are they getting off drugs, or at least reducing their drug use or using less harmful drugs? We do not even know the number of individuals who have been resuscitated in the centre. We get the overall statistic, which is not always consistent. I know earlier this week the Shadow Minister for Health in the other place, Ms Crozier, got two responses, one from the health minister and one from the Minister for Mental Health, around the number of resuscitations in the centre and they were two entirely different numbers. When we are talking about the importance of information sharing, surely there has to be an element there around making sure our data is accurate but also making sure that we are being transparent in our data. The fact is that even though the government has been asked so many times about how many individuals have been resuscitated—is it the same person overdosing three times a day or is it 1000 different individuals?—we do not know, and that is really key data when it comes to analysing the problem we have with addiction and with drug use in the region and how we can better target this and treat this is as a health issue and as a way we can intervene and make their lives different. Unless we are capturing that information, really it is a shell of an idea; we are not following through on what we should be doing. As I raised earlier, the lack of information, particularly for that local community, has been devastating for so many people. These are people who often cannot move elsewhere. They live in the housing towers, it is a high-density population and they cannot easily move to another location. Some people have lived there a long period of time and are becoming quite elderly. I have heard stories from local residents about seeing injecting in the stairwells. I note that the government has now installed syringe containers in the stairwells, and these are not for residents, they are for people who travel to that area because it is easier to purchase drugs there and they can use them in the stairwell. They choose to do that rather than to go to the injecting room, which in itself says to me that there is a failure there and it needs to be reviewed. We have got residents who are walking to the laundry and they are too scared to go into their own laundry in their building because they have walked in on people who are using drugs, they have walked in on people who are in the midst of sexual acts. This is not how we should be providing any housing in the state. Nobody should have to live in that environment, particularly not when it is public housing operated by the state government to provide housing for some of the most vulnerable people in our community. If this is not addressed soon by the government, I really am concerned about what will happen to those individuals. I know already there is some indication that there is significant mental harm happening to people who live in that local area. I note there has been a slight shift this week from the government in their determination that this is something that has to stay in that local area and because it is saving lives it has to be done at any cost. But when you look at the criteria of the injecting room, and there are six criteria, I think it is quite clear that the government has failed in delivering an improvement in those six areas. There are more ambulance call-outs and there is more violent crime in the area. We are seeing a huge impact to the amenity of the local area. There are more syringes around, even though there is an increased number of clean-ups happening and a lot of money is being spent by the government to clean up syringes. It has really had a huge detrimental effect. Women who are pregnant or with young children are avoiding their local community health centre because of the fear of seeing someone who has injected ice in the injecting room or someone who has been around the local area and has got some drugs and is aggressive. They fear they will be bailed up and they just cannot predict what the behaviour will be. We know of parents who send their children to Richmond West Primary School who are seeing more and more drug use on the streets in front of their school. Recently the government installed additional security gates around the primary school—so not just the fences we saw installed when the injecting room first opened but additional gates in and around the area. Let us look at this from a sensible viewpoint and take the politics out of it: is this really what a government wants to look back on with pride, what you are doing to the Richmond community? This is having a huge impact on the local community. There is a way that you can do this much, much differently, which would provide a better outcome for people who are in the midst of drug addiction and also be better for the local community. I urge the government to immediately look at that, particularly in relation to this bill in making sure there is a proper focus on the information that is collected around the injecting room but also that that is made transparent to the community so there is a level of accountability, which we are not seeing at the moment. When it comes to information sharing and difficulties within the government, I cannot help but relate to some of the very stressed phone calls I have received over the last two days from our local primary care partnerships (PCPs) in the region. It is not just from people who work in the PCPs; it is from people who receive their services in the wider area and even people who work in the department who had no idea that that bombshell was going to be dropped on them, which they heard earlier in the week, that PCP funding will be cut from 1 January. PCPs are so important. I speak on this with some experience. I used to be on the executive of the Wimmera PCP. Primary care is a service which is not provided by any other organisation in our local area. It is not a primary health network. A PHN is a much, much different beast, more closely related to general practice and funded by the feds. PCPs are absolutely amazing in how far they can make money go. They can cobble funding together, and they know where the health service gaps are in the local area. To think that there would be any suggestion that it would be worth a $40 million benefit to the government—it is a drop in the ocean in the health budget and a saving around that—when you look at how much they deliver for our communities, it is absolutely astounding that that would even be considered. It is also going to create a huge cost. You are not going to save any money by cutting PCPs; you are actually going to end up still having to deliver these services but at greater cost. You have got ongoing contracts to at least July of next year. You will have to pay them out, and we will not get the services that we need for that region. We have got leases in place. We have got employment contracts in place. The way people found out about this was disgusting. Staff are finding out they are going to lose their jobs in January, just after Christmas, because the minister refuses to commit to ongoing funding for it. There was no formal briefing about it. There was no information given directly to these employees. It was done in really the wrong way. Most of all, there has been no recognition of the impact this will have, particularly on rural communities in Victoria. I just want to build up and give a picture for the people who are in the chamber today around what PCPs actually do. When you look at my local area, we have had a PCP for 20 years. Ms Halfpenny: On a point of order, Acting Speaker, I understand that as the lead speaker on this bill there is some latitude in terms of the width of the debate, but I think the topic at the moment is completely not relevant to the legislation that we are debating today. I ask you to bring the member back to the bill. The ACTING SPEAKER (Mr McGuire): The lead speaker does have leeway in the contribution, but I would ask the lead speaker to come back to the bill. Ms KEALY: I will speak on the bill in relation to information sharing. You do not tell someone they have lost their job through a response in question time that funding will be cut. That is not acceptable. That is about sharing information in the health system, so I think this is entirely relevant. I would like to again have the opportunity to go through the services that the Wimmera PCP currently provide that are at risk now that the government have confirmed they will cut funding from 1 January, most importantly around mental health. These guys deliver our mental health first aid training in the region. They have received state funding because of the recurrent drought in our region. They have received mental health first aid training, but they will have no ability to deliver that in our local area if the funding is cut from 1 January. This program saves lives. I spoke to the minister when the drought was first emerging to talk about suicide hotspots in our region. It is so important that we continue this funding for PCPs so we can continue to close the huge gap in mental health support and services in our local area. We will lose lives if this cut to PCPs goes ahead. I cannot be more clear about that. We also have other really important things. The rural outreach worker is another that I am so passionate about. This is again around providing mental health services for people in our local area. We know that we do not have enough mental health practitioners in our region. It is something that has come up through many audits by the Auditor-General in the past. It has come up through the royal commission as well. We cannot afford to have further cuts to mental health providers in our local area. There is cultural awareness training and really important elements of the family violence royal commission recommendation implementation, including the StandBy program. Our drought program, the seasonal conditions meeting and telehealth pilots are important to our local area. These guys do so much. Please do not cut their funding. It will be absolutely devastating for our local area. And of course that leads to the future of bush nursing centres, where it is understood that there will be a similar cut to funding from 1 January of next year. Bush nursing centres—and I have got four in my region: Balmoral, Lake Buloke, Harrow and Dartmoor—do an amazing job. There is no other primary care in their local area. We have bush nursing centres that are pulling in a GP every so often and that have nurses who are trained up to do wound care, to be that first responder because there is not an ambulance locally and to make sure that people are getting the health support they need—even wellness programs and pulling everyone together for a morning tea or talking about mental health, doing really important things for their community as the only health service providers in the local area—and we need to make sure that these guys are funded on an ongoing basis. Just because you have not got a large community base and you have not got a lot of people around, it does not mean that you do not deserve access to public health care in this state. I do urge the government to change its mind to make sure that they do continue to fund PCPs and to make sure that they continue to fund bush nursing centres, which are already on their knees after the EBA increases were not fully funded by the government. In some of our bush nursing centres that has resulted in a cut to the programs that they provide and a cut to the services that they can provide to their community. This is just wrong. I urge the government to urgently review their position on bush nursing centres and PCPs and to provide that funding sooner rather than later. Mr Pakula: On a point of order, Acting Speaker, you indicated that the lead speaker has a degree of leeway, but you did ask the lead speaker to return to the bill. I have sat here since you gave that indication to the lead speaker and have listened, I think reasonably patiently, while she put those things on the record that she wanted to in regards to her electorate, bush nursing services and the like, but the member for Lowan has now been going for over 20 minutes. The fact is that this bill amends the Tobacco Act 1987, repeals the Access to Medicinal Cannabis Act 2016 and has some consequential commentary in regard to information sharing across the health system. I think the member for Lowan has had a pretty good go in terms of ranging far beyond the confines of the bill, and I think if the member for Lowan does not have a contribution to make about the bill itself it is probably time, Acting Speaker, for you to sit her down. The ACTING SPEAKER (Mr McGuire): The member for Lowan, on the bill. Ms KEALY: The fourth element of the bill is around the miscellaneous amendments of which, in my view, the most important element of which is that the mental health complaints commissioner has a refit of its governance arrangements so it aligns with the health complaints commissioner. This is of course very important, and it is something that has been brought up through audits in the past. But I do think the elements within this bill fall short in that there are other recommendations, particularly from the Victorian Auditor-General’s office from audits that were performed earlier this year, specifically related to access to mental health services and also child and youth mental health, which refer to significant recommendations around improvements to the governance structure in relation to mental health and child and youth mental health services. In particular I refer to recommendations 6 and 11 from the child and youth mental health services report which were relevant to changes to the chief psychiatrist’s relationship with the government. I know from sitting through the briefing in relation to this bill with the Auditor-General’s office that there were serious concerns about a recommendation in relation to the chief psychiatrist’s relationship with the Minister for Mental Health, their opportunity to meet directly with them and raise issues with the minister directly was a recommendation arising from this audit. Sadly, this was also a recommendation from the audit a couple of years beforehand, so we have not seen a response from the Department of Health and Human Services to that very simple recommendation, which would vastly improve the government’s program in relation to mental health, and particularly child and youth mental health. There were consistent themes when you look at the Auditor-General’s report in relation to governance and information sharing. I do not believe that the opportunity has been taken to implement these recommendations through the provision of those associated bills. It could have gone a lot further. There is a lot of information that we are also picking up through the submissions to the Royal Commission into Victoria’s Mental Health System, and the evidence that is being heard through that forum is that there are certainly a lot of shortfalls when it comes to the way that information is shared across the mental health system. I will refer to an individual case that I am very, very aware of and it is a consistent theme I have heard from so many people who are carers, usually parents of people who have severe mental illness. Their child is an adult, they will be admitted in crisis to a hospital bed for mental health care. They are then discharged—they are self-discharged usually—and there is no notification given to the parents. Sadly we see that this person has taken their own life after discharge because they did not have any care arrangements around them. I know that this evidence has been brought before the royal commission, and I do feel for the parents who have had to go through that. I would like to make specific mention of Vivienne Blennerhassett. She has done such a great job in advocating on the loss of her son. I stand by her and I know that her voice will be heard and we should see recommendations which would support a stronger system so that what happened to her son does not happen again. Unfortunately, though, we cannot wait for the royal commission. This was found in the access to mental health services audit by the Auditor-General in relation to their conclusion, and I would like to quote from that report: The Royal Commission into Mental Health will undoubtedly highlight many areas for improvement across the system. However, the need for planning and investment to meet demand is already known and as such work to address this should not await the Commission’s recommendations. Further delay will only amplify the problems the Commission seeks to address. I absolutely agree with that. That is why it was absolutely shocking to see in this year’s budget that community mental health was again cut by this government by a further $20.4 million. In one year we are seeing a huge cut from about $130 million to $110 million. This has an enormous impact on community mental health services, and this impacts a lot of those names that we know so well that deliver great mental health supports to our local people: Anglicare, Ermha, Mdas, Mentis Assist, Mind Australia, Neami, Victorian Aboriginal Health Service Co-operative Limited, Wellways, the Florey Institute and Victorian community health centres. These guys cannot afford to get cuts. These guys are delivering that first point of call and care for people in the community who have mental health issues, keeping people well and out of our overloaded hospital system and public mental health crisis beds. We should be doing all we can to keep people well, but the government’s cuts to this will not ever, ever help people with mental health issues. Just in closing I would like to make a final mention. Today is R U OK? Day. This week is world suicide awareness week. I think the whole Victorian community was substantially rocked earlier in the week with the loss of Danny Frawley. Everybody knows somebody who has a mental illness, but often on R U OK? Day the last person we ask if they are okay is ourselves. So please, to anybody out there who is feeling a little bit off, who does not feel like they are quite on top of their game, they are not seeing the same light in the lives of people around them or getting the same joy from life—if you are not feeling 100 per cent, if you are not feeling okay, talk to a mate, make sure you are engaged with your local mental health services, get an appointment with your GP for a mental health referral. But whatever you do, make sure you put yourself first. You are worth it. You may think the world is better off without you. It is not. We value what you do and we value the place that you have in the world. I just encourage everybody to take that on notice and ask themselves if they are okay.
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