It is wonderful to kick off debate on legislation. It has taken us until a quarter past 3 this afternoon, with 1 hour and 45 minutes left, to debate this legislation, but it is very, very important. At the outset I would like to acknowledge all of the health service workers in the public and the private health services right across Victoria. It has been an incredibly difficult time working within health care for the past decade but particularly since the COVID epidemic and the lockdowns, which had a significant impact not just on health service workers having to work through the infection control risks through that period but also with the mental health impacts, the impacts on our workforce and the impacts on our community. It was our health workers who were front and centre of that response, and I do thank them for their work. There are some that just simply have not had a break since then. They did the heavy lifting over the pandemic, and they certainly do not feel like they have had a break up to this point.
This has been compounded by some savage cuts to the health sector, where there is an expectation that our health services do more – much, much more in some instances – with much, much less. This is made a lot worse by the fact that we have had significant cuts to the primary healthcare services, the grassroots mental health and healthcare services and the community health and preventative health services – the things that make a difference and help people maintain their wellness in the community – and have had to put that impact further down the line, the ambulance at the bottom of the cliff as we often talk about in health care.
The expensive end of health care, the part of health care which is the most expensive, has the greatest implications on recovery, whether it is a mental illness or an event that has occurred or whether it is about mental ill health or about a mental illness. If you are having to go to hospital for treatment, you have missed every step before that. That is something that is extraordinarily problematic in the state of Victoria at the moment. All of the money is really being directed right to the end of the healthcare profile rather than keeping people well, keeping them in the community, keeping people engaged and making sure they are staying on top of those health issues. It is something that is of great concern to me as someone who has experience working in the health sector itself.
We know that that is further complicated by the extreme cost-of-living pressures that every Victorian is facing at this point in time. It is very difficult for me and the team in the Lowan office to hear from people who are having to choose between putting food on the table and seeing a doctor, sending their kids on a school camp or buying a new uniform for them or making a decision about whether they get those braces for the child or making sure that there is occupational therapy or social work that is required for a child who is neurodivergent, with the thousands of dollars that it costs to go to a mental health professional to get a diagnosis for their young child. You know that is what they need before they get to school so that they can have the best possible learning opportunities and to take a lot of pressure off that home environment, to make sure that parents and educators, all of the carers for that child, have the tools that they need to bring out the best in the child and support the child.
That is something that is very, very important to me and my colleagues within the Liberal and National parties. It is wonderful to have the member for South-West Coast, my electorate neighbour, who is also a healthcare professional – a nurse. You are never a former nurse; you are a nurse. You have those skills and that experience throughout your life. I know that there are many within my team that would be able to respond and provide support if there was an issue that came up. The Shadow Minister for Health in the other place Ms Crozier is a former nurse – or a nurse still, if I keep to my language – who is an exceptional advocate and campaigner for a stronger healthcare service across Victoria but also for better supports for our health service workers, as I acknowledged earlier.
This legislation is, as it is named, a regulatory reform. There are four key aspects to this piece of legislation that will be debated today. The first is in relation to assisted reproductive treatment. The bill also makes amendments to the Non-Emergency Patient Transport and First Aid Services Act 2003, and I am certain that any members in rural or regional Victoria will be able to contribute to this with firsthand experience around some of the challenges that our constituents face when it comes to accessing non-emergency patient transport or simply getting to appointments that can have serious life implications.
This legislation will amend the Public Health and Wellbeing Act 2008 in relation to the registration of cooling towers. For those who are of a similar mind, in my health experience I started off my career as a biomedical scientist working in a laboratory. In relation to Legionnaire’s disease, I diagnosed one case of that in my career back in the olden days. But with cooling towers, I think there was a matter discussed on 3AW this morning where somebody had come back on a flight from overseas with a suspected infectious disease and there were no public health staff available to support them and provide additional support over the weekend for what could be a particularly contagious event. It just shows how deep the cuts have been from the Allan Labor government when it is seen as a non-frontline service to have access to important infectious disease support and information for our public health workers across the system. The bill does make amendments as well in relation to the Radiation Act 2005. I would like to speak to that a little bit further during the debate, because during the bill briefing there seemed to be a level of evasiveness around the rationale behind this and a reticence to share some significant information that the EPA had provided to the government in relation to why this amendment was required. We will discuss that later on in my contribution today.
In relation to this legislation, there have been a number of concerns raised from those businesses who are involved in assisted reproductive treatment. We know that there have been significant issues which have caught media attention, and for those who work closely in their electorate offices I am certain that there are people on both sides of the chamber who have had discussions, particularly with women who are going through the process of assisted reproductive treatment. They may have friends or family members who have sought assisted reproductive treatment. They may have gone through that journey themselves. Any woman who has had to enter into that process – or if you have known anybody who has – knows how difficult it is for so many reasons. It is difficult on your body to have hormonal treatment and to have that structured and very regimented routine over when you have your injection, when you have your window of opportunity to conceive and when that all comes together, being in the right place at the right time. And of course there is a significant amount of money involved. There is a significant amount of heartbreak involved for many people. For some it never sticks. For some they have the greatest joy of their life and they do not look back ever.
It is as emotional as it is difficult physically to go through, and it is financially a huge challenge for so many people and simply unaffordable for many, so it is important to support families that are going through this process so that they have confidence that the organisations that will be managing the reproductive treatment will be doing so in a way that ensures that the embryos are theirs. We have had instances where that has not been the case, where somebody has found out later on that the wrong embryo has been transferred, including the story that we would have heard a few years ago about a woman giving birth to a stranger’s baby and the legal complications of that. It is a heartbreaking situation, if you put yourself in those shoes for just a short period of time, for both the donor of the egg that provided that embryo but also for the birth mother. What a difficult situation to have to confront when you have created that connection with your baby which turns out to be not your own. Is it your own or not? It is a very difficult argument and psychologically extraordinarily difficult.
We also know that Monash IVF settled a class action brought by hundreds of patients in relation to a bungled genetic testing program, while further revelations came to light that Victorian IVF clinics were vastly under-reporting the actual rate of dangerous complications. There has been a lot of focus on this, not just in Victoria but nationally, and all Australian health ministers commissioned a national rapid review back in June 2025 and agreed to its recommendations in September of last year. The rapid review found multiple failures of the current system. This is not surprising given the incidents that we know about, let alone the ones that we are not aware of that have been managed privately – even further for those who do not know that they have been involved in a bungle of some description.
The main recommendation from this rapid review was to move away from industry self-regulation to government oversight, with the Australian Commission on Safety and Quality in Health Care to be responsible for accreditation of fertility clinics. This is a body that already oversees accreditation of hospitals and other health services. This is something that is being worked through at present, and the feedback that we are getting from some assisted reproductive treatment organisations is that this legislation is a step ahead of where the national reforms are. While there is absolutely a general consensus that we need better regulation, better oversight and better scrutiny over assisted reproductive treatment, we also need to understand that there is a national program that is coming. We need to ensure that this process of transference from the current system through to what the future system looks like does not involve an interim responsibility of new standards or a new body coming through which creates a further chance for variations in treatment and oversight or differences in the standard of support and health care that you would expect if you had IVF or assisted reproductive treatment here in Victoria versus other states. The intent is to keep it at a high level and consistent across all states. That is something that I think is very important.
I highly respect the input that has been provided from different assisted reproductive treatment services, because they are looking at this with the view that things need to change but we need to ensure that the change is a positive one and does not create any unnecessary confusion or harm, particularly for those who receive and engage in these services. In particular there are concerns that have been raised in relation to RTAC, the Reproductive Technology Accreditation Committee, that that accreditation will be abolished as a registration requirement but in its place the secretary may approve one or more accreditation schemes, with registered ART providers required to comply or face penalties of up to 60 penalty units for a natural person and 300 penalties for body corporates. This replacement scheme has not yet been developed. This is what we are facing with the legislation today. It is something that will be delivered through a future change, and that is a concern to the organisations that will have to work under this new scheme. We do not know what we are working towards, but we are cutting what is already in place.
What we found during the briefing was there will be two processes in place, two different schemes in place, for a period of time, and that is through the transitional provisions within the legislation, proposed sections 169 to 171, which allow the secretary to approve two concurrent schemes immediately after commencement, recognising that some providers will remain RTAC accredited while others might be accredited to the Australian scheme. However, the requirements of the new scheme are entirely unknown, and members will have limited ability to plan or assess compliance costs until the scheme is published.
It is extraordinarily challenging in health care because there are so many standards and so many quality assurance programs that you are involved in. Something that is important to take consideration of is while this all ensures that there is a higher level of certainty for consumers, it does also mean there is an additional input of administrative time, of scientists’ time when it comes to ART and of clinicians’ time to make sure they are meeting those standards. If you are doing two standards side by side that can compete, it can consume additional time and it can mean resources are taken away from delivering the services that people are seeking, which are about making sure that more parents who are seeking to successfully implant an embryo are able to do so. While this is not a deal breaker, it is something that I would urge the government to consider very carefully as this legislation is brought into practice.
It is a challenge. I know even back in the olden days, when I was CEO of a health service, we had six different accreditations that we had to go through because we delivered aged care, we delivered acute care, we still had an operating theatre and we had a variety of allied health and community health services that we delivered, including dental services. We also had the usual accreditation that was required to ensure that financially your transactions were sound and no-one was taking money or inappropriately accounting for public funds. There were six accreditation processes that we had to go through. It was incredibly time consuming. It took funds out of the service. Sometimes it was a process where there was an incredible amount of duplication, which did not necessarily result in a higher quality of care or a higher level of transparency. Most importantly, there was a lot of information that went into these agencies, particularly the public health department, but there was not a lot of information coming back on how you could do better and how you could aspire to improve your system to make sure you did run a higher quality service, a more efficient service and a more productive service. That is something that is required. We cannot just have these lumping big departments with lots of staff that collect a lot of information but do not support our health services to deliver better health services for our people. It is something that may be an ideology for me, but I think that it would be good to get back to a system where the government and departments work for the organisations that are delivering frontline services rather than being a barrier – a cost barrier, a time barrier, any sort of barrier – for these people who are on the ground and who want to just get on and do their job and do it well. Certainly the member for South-West Coast and I are working hard to ensure that we can be in government sooner rather than later so we can end the waste, stop the corruption and get our health services back to supporting people when and where they need it.
We are hearing from other organisations. The feedback that I read in earlier was from the Australian Private Hospitals Association. We have also had feedback from Melbourne IVF. We have heard from them that:
- The introduction of the Bill is premature as it seeks to materially overhaul how the ART sector is regulated in Victoria before there has been any significant progress on the national accreditation scheme currently under development.
- Any reforms to accreditation requirements should wait until all stakeholders have a clearer picture of the structure and contents of the national accreditation scheme and standards, and should be accompanied by appropriate consultation with affected stakeholders.
- The Bill, if passed, will lead to increased cost and uncertainty for patients. This is including because it will lead to the creation of an interim regime pending the launch of the national accreditation scheme, which will require ART providers to significantly update their processes twice in a relatively short period of time.
- The proposed reforms will also not make ART treatment safer or more widely available, or lead to more successful outcomes, for patients in Victoria.
- There are aspects of the Bill that appear to have been rushed as numerous details still need to be properly worked through. As such, at the very least, the proposed reforms will require further consideration and consultation before the Bill is enacted.
This is not something that we made up ourselves; this is something from the people who deliver ART services, and I would urge the government in the time that is available between the chambers to take action, to make note that there is an opportunity to have further consultation with the people who will have to deliver these changes, the people who provide support to the patients, the people who make IVF a reality for so many families. We need to ensure that this is done right, and I do urge the government to take heed of these organisations, because feedback is required for a reason, and that is to make sure we do it once and do it right, not do it multiple times and create additional cost barriers and confusion and perhaps even inadvertently create a more dangerous system on the way through.
Further to this legislation, I would like to speak to the element regarding non-emergency patient transport and first-aid services. This aspect of the legislation makes a relatively minor change. It expands regulation-making powers in relation to the incorporation of documents, and this is to support greater communications and make sure that there is a pathway for information sharing, particularly for the non-emergency patient transport and first-aid services that are out there.
In relation to non-emergency patient transport, we have seen a critical impact from some recent cuts by the Allan Labor government, and we had really upsetting contact from a constituent just last week who was on the list for a liver donation and lived in, I think you would call it, remote rather than rural Victoria – the Yarriambiack region. She is an older woman who does not drive or is not comfortable driving long distances. Her husband is not well at this point in time. She was told that if a liver should become available, she would need to get to Melbourne within 6 hours. We do not have access to public transport at all in some regions. For some it is maybe one trip a day that goes from our region through to Melbourne. It is certainly not something where you could have any confidence that public transport would be available within a 6-hour window to get you from point A through to Melbourne. It was extremely difficult to have the conversation with someone who is at that level of liver failure, where they were in such distress that they would miss out on their opportunity to get a transplant because they could not find anybody to take them to the appointment. This is information that came from a social worker in the public health system that was basically: if you do not get there, you are going to miss out.
We need to have a health system where there is no wrong door, where we take the time to understand the limitations of access to health services and particularly patient transport in rural and regional Victoria. We need to make sure that we do not have a situation where someone is mentally distressed and think they are going to miss out on a transplant because they have got no idea how they are going to get to Melbourne within 6 hours and they do not have the means to access that through their health services. It is problematic, and it is not just this one incident alone. We are hearing repeatedly of people who cannot access non-emergency patient transport for chemotherapy or radiation treatment. People are choosing – if they cannot find a family member, if they cannot find a friend, particularly through the fuel crisis where costs were so high that they felt like they would be a financial burden on the people around them – and people are making excuses not to have life-saving treatment to take the burden off the people around them. That is just such a hard conversation to have; it is very, very difficult. And for those of us who have loved ones who have been through or are going through cancer treatment, you cannot imagine that that would ever be something that they would have to consider as an option. It is a very difficult situation. There is more that can be done within patient transport services, particularly for rural and regional people. People are missing out on health care far too often, simply because they cannot access a public way, a supported way, to get there. That is creating a community of haves and have-nots in Victoria. No-one should miss out on health care simply because they cannot drive long distances, yet that is what is happening under the Allan Labor government, and it is disastrously bad; it is heartbreaking.
I would like to further mention access to health care in rural and regional areas, particularly in relation to bush nursing centres, because often they are the ones that provide that non-emergency patient treatment and community health, primary health and often ambulance services as well in our rural and regional areas. They have not had an increase in funding for an extraordinarily long period of time.
They have had EBA negotiations to increase and improve the pay for their nursing staff, and no-one begrudges that. But if there is going to be a government going in to negotiate a higher EBA, then that same government should be delivering a higher level of funding so they can actually pay their staff at a higher rate to continue the same number of hours for those staff, particularly in those small communities, and not have to look at what services they cut.
I note earlier in the week the member for Gippsland East, who also hosts a large number of bush nursing centres, made mention that one of his bush nursing centres was having to go from five days back to four days. There is diminished access to health services, and this is the problem with the centralised system. We have really novel healthcare services around the state, people who do things a little bit differently, who need flexibility in how they deliver care, how they deliver health care, and yet this is being taken away by a series of cuts, by productivity gains through the service, and we end up with fewer hours, fewer services and our local people paying the price for a Labor government that is insistent that only the big health services are the ones that matter. That is not the case.
We need to support bush nursing centres in our smallest communities. They need to see an increase in funding. We need to see more support for patient travel, particularly in our rural and regional areas. We need to make sure that we have got funding in place for people in my community. Recently I heard of an instance in Horsham where somebody was looking to see a specialist and they were unable to because the funding had been cut by the Labor government, and so that specialist was no longer able to travel to Horsham, which is the 10th largest regional city in the state. I had an instance also the other day at Grampians Health where somebody had been diagnosed. They had a very, very high PSA; they had a PSA that was simmering for a long time, then it just spiked, and they were told that they would not be able to be referred to a urologist as there simply was not one available to be able to send out to Edenhope. To leave somebody in that situation, where they were told just to take some magnesium – ‘It should help you sleep at night’ – is not any reassurance, and it did not help that person sleep better at night. I am very, very grateful and thankful that that individual instead went into South Australia, and today they started their treatment, their radiation treatment, and I wish them all the very, very best. They have got eight weeks of care over there, but they could not get the care they needed for prostate cancer in Victoria, so they went to South Australia.
That is what is happening in Victoria. That is not good enough. That is not good enough for any Victorian, and I challenge any of you to think about how that would feel if that was your family member. How would you feel if that was your father who could not access services here and was told, ‘You can’t get a urologist in Victoria. You have to go to South Australia. We can’t help you’? That is not good enough. That is something that everybody should be –
Mary-Anne Thomas interjected.
Emma KEALY: Well, former Minister for Health, I am more than happy to put you in touch with that person, because that person is my father, and I trust him implicitly. He started radiation treatment today. My father started radiation treatment in Adelaide today because the former Minister for Health centralised services into Ballarat. He could not access radiation treatment in the state of Victoria. He could not access a urologist in the state of Victoria, and he has gone to South Australia. If the former Minister for Health would like me to pass on his details, I would be more than happy to – or my mother’s, who would be more than happy to talk about it as well. It is heartbreaking, it is wrong and nobody should have to face that. Nobody in this state should be told they cannot get health care in Victoria. Nobody should get that – not me, not the former Minister for Health, not anybody. I would not wish that on anybody, but this is what happens in Victoria. It is what happens when you have got a government that is happy to throw away $15 billion, including on strippers on Big Build sites – money that should be invested in our health services in Victoria. It means Victorians are missing out. Members interjecting.
Mary-Anne Thomas: On a point of order, Acting Speaker, the member is now straying way off the bill, and I ask that you bring her back to the matter at hand.
The ACTING SPEAKER (Wayne Farnham): I remind the member of the bill. You have been relevant to the bill, but you did stray a little bit, so just come back.
Emma KEALY: I think that health services across the state should be funded appropriately. When they have significant funding cuts because money is being spent in ways that are completely wasteful, that support corruption in this state and that will not be investigated by Premier Allan and all of the people who stand behind her and who have confidence in her leadership of this state, I can tell you there are a hell of a lot of people right across Victoria – not just in National seats, not just in Liberal Party seats, but in Labor Party seats – who have lost confidence in Premier Allan and the Labor government. They have lost confidence that Premier Allan and the Labor government are making decisions for the people of Victoria. It feels like there is just desperation and chaos. There is such urgency and fear about what people actually want to do. All of the Labor members want to keep their own seats. They have forgotten what it is all about. They have forgotten they have been elected to represent the people of Victoria.
Paul Edbrooke: On a point of order, Acting Speaker, I fear that the member is again straying from the bill.
The ACTING SPEAKER (Wayne Farnham): The member may have strayed a little bit from the bill. I ask you to be relevant to the bill.
Emma KEALY: I will stand in this place with all of my colleagues from the National Party and all of my colleagues within the Liberal Party and put forward a positive plan, because Victorians deserve better. Victorians deserve a safe pair of hands that will actually focus on Victorians, that will deliver better health services, that will make sure that our schools are high quality, that will be able to support the teachers, that will make sure there is no more waste and that will put in a royal commission to get to the bottom of the corruption in this state. We will get rid of the bikie gangs. We will hold all of those people to account who have done the wrong thing.