I continue on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2026. This is a very important piece of legislation because the aspiration, what the government is setting out to achieve, is a good thing and is important. We need to ensure that people who enter Victoria’s public health system receive the support and care that they need and deserve. In health care there is a very important driver to better patient outcomes, and that is the right care at the right place at the right time. This is never more emphasised than when you live in rural and regional Victoria, where access to health services is much more difficult.
My colleague and electoral neighbour the member for South-West Coast can attest to this. The challenges that we face in south-west Victoria and western Victoria are a different perspective than what residents of Melbourne have to face when it comes to attending a health service and getting an appropriate level of care. This is not a reflection on the healthcare workers themselves. What unfortunately happens as a result is when you look at the health outcomes in our electorates in rural and regional Victoria, we are on top of the worst indicators. We have a shorter lifespan, we have a higher rate of mortality five years after diagnosis of cancer and we have higher rates of heart disease and of lung disease. Skin cancer is another – we have higher rates of that. Something that I am certainly noticing – and this is just an observation rather than being evidence based – is that the number of men diagnosed with prostate cancer in my electorate is exceptionally high.
I will take prostate cancer as an example. The challenge for men who are diagnosed with prostate cancer in my electorate of Lowan, particularly around the Wimmera region, at this point in time is that Richard McMullin has retired. He was the urologist who serviced from Ballarat right through to the border. He is a very good human. I know Richard well. He was the urologist in charge of my father’s prostate cancer. He retired a little while ago, and I would like to acknowledge and thank him for his service to health care. He certainly had a huge impact on so many men and women facing urological issues. I do appreciate the contribution that he made to supporting health care in rural Victoria, because not every specialist is willing to do that, and some do not do it as well as Richard did. So thank you, Richard.
But upon his retirement that position has not been filled, and I have had a number of local men come to me in situations where they simply cannot find a urologist within the Grampians Health network that will take on their care.
We have some members of our local community who, rather than travelling to Horsham for care or travelling to Ballarat for care, are actually having to go to Melbourne for care. In this scenario this is of course a long distance. My electorate is a long way away. Horsham itself is about a 4-hour drive. I had a case of somebody who was in Rainbow who had to drive to a urologist in Melbourne – that is getting to over a 5-hour drive. It is not just the cost to do that – there is the Victorian patient travel assistance scheme, which provides a small contribution to cover fuel costs to get to an appointment in Melbourne. Our patients have to travel on pothole-riddled roads, and as we know in rural and regional Victoria our roads are falling apart. I have a resident at Lake Bolac who had to travel to cancer care in Ballarat. In that journey she did seven tyres and fractured five rims. This is the additional cost of accessing care when you live in rural and regional Victoria.
There are not connections that are there when it comes to the public transport system. We still do not have access to a public train system in all of the Lowan electorate. It is 20 per cent of the state, but there is no train service. It is outrageous, and it should be instated. There is the demand for it; there is the need to do it. When you see that we have got free travel in Melbourne on trains and trams, on public transport, our people miss out because they do not have access to those services. It is the inequality that we see under a Labor government. There is so much focus on things that happen in Melbourne, but some of the people who have the worst health outcomes are missing out. They are paying more and getting less under a city-centric Labor government. It is very frustrating for people who live in regional Victoria to feel like they do not count and they do not matter under Labor. We need to ensure that we have access to this care, so while I understand this bill is about nurse-to-patient ratios, there are so many levels to better access to care and better quality of care that are beyond nurse-to-patient ratios.
I was very proud to stand with the Leader of the Liberal Party Jess Wilson and the Leader of the National Party Danny O’Brien at Hamilton Base Hospital recently. I had the member for Gippsland East and the Leader of the National Party, and we were able to announce that the Liberals and Nationals in government would contribute $45 million to finally upgrade the emergency department and intensive care unit at Hamilton hospital. This was so warmly welcomed by the hardworking staff in the emergency department and the wider Hamilton community and across the entirety of the Western District, because that emergency department is falling apart. It is outrageous that our healthcare workers have had to put up with those conditions for such a long period of time. I am so proud to have committed to that at the last election, that $70 million. We have now upped it. We are doing more. We are going to invest $45 million, and I cannot wait to see that happen, because I know that that is the way the Nationals will deliver better health care for local people in regional Victoria. It is time for a fresh start. We need to make sure we get our fair share to regional Victoria, and investing in Hamilton hospital is exactly how the Nationals are going to achieve that.
We know that the commitments within this legislation around nurse-to-patient ratios are important, but there are concerns that have been flagged by the sector in relation to how this will look in practice. While it sounds important – and it absolutely is important – we need to ensure that there is not just a ratio, we need to ensure that we have got positions filled, we need to ensure that we have got enough workforce trained and ready to fill those positions, and we need to make sure we have a workforce that can fill positions in areas where it is traditionally more difficult to attract and retain staff, which are in rural areas of Victoria.
This is often the big challenge when it comes to Labor. It is all very well and good to put in an enterprise bargaining agreement or in legislation a requirement for a greater level of staffing within our health services, but you can only deliver that with the same level of services if the government also provides the funding to that health service so they can pay these staff and so they can pay the nurses at the right level commensurate with their experience and their skills and qualifications. This is what we do not get through this legislation. There were questions put through the bill briefing, which we have not received a response to yet, about what additional funding will be provided to the public hospitals to ensure that they can deliver on this legislated requirement to increase nurse-to-patient ratios. This is the key question, because we need to make sure the funding is there, otherwise hospital boards and CEOs will be in the incredibly difficult position of working out how they can fund a legislated requirement to increase the ratio of nurses to the number of patients that they have.
The only way they can achieve that is by shutting and reducing services. Basically you cannot do anything else within the healthcare system. They have been cut to the bone. There are what are called efficiency savings. Every first of July, the new financial year, the hospitals get their new budget to understand what they are going to have to fund their health services over the coming 12 months. But if there is an efficiency saving – which there always is – it means that CEOs and boards have to make the decisions: how do we fund the EBA increases that are coming through? How do we ensure that we continue to actually serve our community by delivering the health services that people in our community need? And how do we make ends meet? It is about hospitals doing more with less, but it comes to a point where there is only one decision to make, and they have to shut services. This is an exceptionally difficult decision to make, but it is one that is put in place because they have a legislated requirement or an EBA which they have to meet and they are not given the funding by the Labor government to be able to deliver on that. It is a very simple economic proposition which just does not stack up.
It is a challenge for every health service how they deliver on that, because they take their role in the community very, very seriously. They understand that health care and hospitals particularly are some of the key employers in our rural and regional towns and cities. They know that the people who are in those senior positions in health in hospitals are often also taking on leadership positions within the local community. They are taking on positions within the local football or netball club, they are on school council, they are leading in volunteer roles. Many are naturally leaders and decision-makers, and so they give back to their community in so many different ways, so if we do not support particularly our rural health services to have that stream of people in senior positions, in leadership roles, who have got additional skills they can bring not just to their employment but also to the community, we are going to have a decline in our rural communities.
There is also the flow-on effect of what it means for our rural communities if there are not senior decision-making positions in health services in the smallest communities in our state. If we do not have that economic driver of senior positions in health care in regional Victoria and rural Victoria, we take away so much of the support and donations financially from supporting our small businesses in regional Victoria – the donations to our clubs and schools and all of those things that make our regional communities so vibrant. It is not just the volunteering; it is the financial donations as well. This is what makes people who live and work in rural and regional Victoria so special: they give so much more than just turning up, and we should be supporting them and our rural and regional communities at every single opportunity.
In regard to some of the detail around this bill, as I said, there are a number of changes to the schedules or the hospital levels, where a number of hospitals are upgraded or reclassified – that is outlined in the legislation. But I would like to point out some changes relevant to my electorate of Lowan, whereby Grampians Health Ballarat Base Hospital has been classified as a level 1 hospital; Grampians Health Wimmera Base Hospital, the Horsham campus and Natimuk and Dimboola as well are level 2 hospitals; and the Willaura campus of the Ararat hospital, which is just out of my electorate and which East Grampians Health Service certainly has responsibility for, has also been reclassified.
It is a fabulous health service in the beautiful community of Willaura and has one of the most outstanding and generous hospital auxiliaries I think in all of the state. They do an incredible job there with fundraising activities in particular, but also they volunteer an enormous amount of time to support their residents and patients at Willaura hospital. Ararat hospital has been classified as level 3. I would also like to note that there has been a reorganisation of category 3 emergency departments. That category 3 has been replaced to include Hamilton Base Hospital, that fabulous hospital that I worked at about 20odd years ago. It seems like a long time ago.
When you look back and you see some of the people at Hamilton hospital – and we can share memories about how fabulous the muffins were on Thursday in the tuckshop that we would go in and see and look out for – we know that there are some good memories there. It is probably reflective of the culture within our health services: it is a community. People go through the stresses, some of the trauma that they see and the experiences, and they form extraordinarily close relationships that last a lifetime.
I would like to now just go through some of the concerns in my final elements of this contribution. Just as in the previous ratio-amending legislation, it is unclear if the allocated funding will be sufficient to meet the higher cost of employing more casual agency nurses if hospitals are unable to recruit permanent staff. This is the hidden cost of a rapid transition to an increased level of staffing. It is not talking down the increased level of staffing, it is just saying that if we do not have enough workforce to permanently fill these roles, there is an additional cost if agency nurses or locums are used to fill those vacancies – and there is a massive cost around that. It does also have a flow-on effect not just financially but within the culture of a ward. If you shift from stable employees, where people are embedded in the community and they have been working together for a long time – those wards tend to work in a more positive way and are, I think, probably culturally a more positive environment – once it gets to a tipping point, where there are a large number of agency nurses coming through, where they might only work one weekend and then they do not come back again and you have this constant churn and shift, there is a fracturing of what happens within the relationships within that health service. So there is a two-fold cost, as I will refer to it, in terms of these rapid shifts to an increased level of staffing.
Given the significant financial pressures throughout Victoria’s health system, the new nursing ratios could lead to further budget constraints elsewhere, such as in planned surgery and emergency department capacity. This is of great concern to Victorians, because we know these are already areas where there are bottlenecks in the state of Victoria. We know that waitlists for planned surgery have blown out for a long time now, and the Labor government are not getting on top of those, which has an impact on people being unwell and presenting to emergency departments. Then on the other aspect, we are seeing hospital ramping and patients having extraordinarily long stays in emergency departments not just for physiological reasons but also presenting with mental health illness, and that is very, very problematic.
An emergency department is not where anybody who is facing a mental crisis should be waiting for not just over eight hours but sometimes for 24, 36, 48 hours and up to 72 hours. It is not a safe environment for them and can cause an incredible amount of trauma; it is just not appropriate care for that to happen. But we are seeing these wait times in emergency departments continue to extend out more than what the government’s own target times are for these KPIs.
As I referenced earlier, department staff were asked in the bill briefing if all hospitals are meeting the current ratios, which commenced in full on 1 July 2026. This question was taken on notice, and at the time of the writing of this bill report, it had not been responded to, so it would be fabulous if we could get that information to the Shadow Minister for Health before this bill is debated in the other place.
Both the second-reading speech and the Australian Nursing and Midwifery Federation’s feedback refer to the new ratios as providing opportunities for graduate nurses. This comes at the same time that hundreds of graduate nurses missed out on a place in the public system this year, with an expected increase in the number graduating in 2026. There may even be more graduates unable to secure a position. This is something that is quite perplexing to me, that we are actually undertaking an enhanced level of training and we are getting these graduate nurses coming through, but there is not a job available at the end of that training. This is something that is very frustrating and has an impact on graduate nurses as well – they feel like they are not valued. They put all this work in, they were told that there would be a job at the end of it, and then they go to apply and there is nothing there.
We have seen a very similar pathway with paramedics, where a program was established to train up paramedics, and then they go and apply for a position. There are so many that were unable to secure a position, even though we have got so many problems within Ambulance Victoria and we are seeing positions going unfilled for extended periods of time. In my electorate of Lowan, in the northern area, in the Wimmera area, we have not had a MICA paramedic from Ballarat to the border for the last month or longer. In fact there are four positions that have gone unfilled permanently for a number of years now. They have never been advertised. There is no attempt to fill these positions. Of course when positions are not filled, they do not need any money. There are all the budget announcements: ‘You’re going to get funding. We’re going to fund these positions.’ But then they are never filled, so the money never goes out the door and access to care deteriorates and gets worse. That is what I am very much focused on.
Let us look at the outcomes. What are the outcomes to make sure we are supporting a healthy workforce and a workforce that feels valued and important and that they are recognised for the skills, experience and qualifications that they have, versus people who feel like, ‘I’m the only person left out of a team of four. How do I work in this environment when I’m continually being asked to do more overtime, to work additional weekends, when I am spending more and more time away from my family, when so much more is being asked of me because I haven’t got the people around me to fill these positions?’ This needs to be addressed. It is a critical problem because there are people who are not able to access MICA services in my area, because we do not have anyone filling the roles. This is putting so much pressure on our local paramedics. It is not fair to do that, and it must be addressed.
The Australian College of Nursing also raised concerns around this legislation that additional funding may be needed to meet the higher cost of employing more casual agency nurses. Legislative ratios combined with workforce shortages increase reliance on agency nurses, which can impact hospital budgets and also affect continuity of care. The Australian College of Critical Care Nurses also provided feedback. They too support the bill’s intent to strengthen intensive care services but raised concerns about whether there is a sufficiently skilled critical care nursing workforce to meet the new staffing requirements – so a commitment that we will have these positions available. But how do we fill them? Because we have not got enough critical care nurses trained up to deliver those services, and they have not got enough experience to deliver those services. Let us be clear: critical care nurses are amazing. They have so many skills that are vital, particularly in rural and regional hospitals, where the more skills you can have on deck, the more flexibility you have in the type of care you can provide and the types of patients that you can treat. It takes so much pressure off the entirety of the healthcare system. We absolutely need to see more critical care nurses trained up and embedded into the workforce, but there needs to be a commitment. How do you train that workforce to be available to fill these roles? The ACCCN highlights the importance of workforce capability for safe ICU care, not just numbers of nursing staff. They warn that expanding staffing numbers without expanding the pool of suitably trained critical care nurses could lead to shortages of experienced staff and difficulty filling senior ICU positions, and that would be an unintended consequence. We do not want to put more pressure on our senior, most experienced clinicians because they are not well supported enough.
There is one other matter that I would like to raise, in relation to some of the challenges that we have seen over the past probably eight years where it has been rolled out – that is, the merging of multiple health services into one single health service. I would like to particularly point out the merger of a number of hospitals in the Wimmera to form Grampians Health. Before this was announced there were certainly grave concerns flagged by community members. I even recall Bill Ower, who was walking up and down the main street of Horsham with a sandwich board on. If you look at what was on that sandwich board, he highlighted then exactly what is happening now. In Horsham we have had a terrible hit to culture among our fabulous healthcare staff. I would like to acknowledge them, because I know they are doing their best in a really difficult environment, but they feel like decision-making has been taken away from them and centralised to Ballarat. Senior roles have been removed and shifted to Ballarat, which let us face it, is 2½ hours away from Horsham. When there is a shortage of specialists – Dr McMullin retired; we have got a shortage of urologists – they are not sent to Horsham; instead the patients are sent to Melbourne. There is a diminished availability of access to services. There have been extended periods where dental services have not been available.
The social worker very early on was removed from Edenhope hospital. The dental services have been completely closed at Edenhope hospital. We see so many services that were being provided under the older model, which may have been more for the department to manage because there were more CEOs to manage – and not all CEOs are straightforward and easy to work with; some challenge the department and want to do things differently and fight for their local people and deliver the services that their community needs. But there are local people that are missing out on access to health services, and this has not changed since this merger took place.
This merger is far too big. Ballarat should not be within the Grampians Health network – it should not take control of the hospital – which goes right through to the border of South Australia. It is not fair for anybody with an exceptionally high prostate-specific antigen to see a GP in Edenhope and be told, ‘I’m sorry, there is no urologist we can refer you to within the Grampians Health network. If you are having trouble sleeping, take some magnesium.’ That is disgraceful health care. That is not what should be delivered and it is not caring at all. We need to make sure our public health system is there for everybody in our community in Victoria, no matter where we live. I would urge the government – I know there are only perhaps a few months left – to reconsider and review Grampians Health. As I said, the staff are amazing. They are doing absolutely the best they possibly can. But Ballarat hospital, a major hospital with its own funding issues, its own bed block issues, its own emergency department issues and its own culture issues, should be stand alone and do what it is good at. Their core business is not managing small rural health services, and it is people in my electorate of Lowan who are paying the price for that decision. I urge an urgent review of that because it is unacceptable for our people to miss out simply for an experiment that has not worked. If there are mergers that might happen that might bring in efficiencies, this is not one of them. It has cost more and our local people are getting less.
I would like to, just in my final minute and a half, go back to one of the key and core foundational things of our health system, and the member for South-West Coast just mentioned it. Hospitals are far more than just hospitals and somewhere you get treatment. They are more than somewhere you turn up in an emergency department or where you go and have a baby or visit a loved one and they provide support and care as you age and get older and are faced with a diagnosis which is difficult to deal with in the short-term – perhaps terminal – and you require palliative care. What is important about our hospital system is the care that you receive. Health care cannot be delivered without fabulous healthcare staff. It is the staff that provide the care. It is not the system, it is not the bricks and mortar and it is not the government of the day; it is the people who work within the healthcare system that provide that care. And so as I opened, I would like to acknowledge everybody who contributes to health care in this state. It is from the nurses to the doctors to the allied health professionals. It is the cleaners, it is the people who work in the kitchen, the people who work in accounts, anyone who answers the phone and the people who are responsible for the quality system, the occupational health and safety system. It is the people who are looking at doing things differently and providing a healthcare system that wraps around the patient rather than works in silos. I thank every healthcare worker for their contribution to Victoria’s health system. You deserve the support in every possible way to make sure you can do your jobs well and at the highest possible quality.