I will begin by stating that Derryn Hinch’s Justice Party supports this legislation.
As I said in my speech in February 2019 on the forerunner Bill to this one, I commend the Government on its establishment, in law, of the nurse-to-patient ratios that are again at the heart of this new Bill. I also congratulate the Government for what I regard as its clear willingness, in this area, to introduce incremental changes to the Safe Patient Care Act in order to continue to enhance how it actually works in practice.
On that note, I am pleased to see that two specific concerns that I raised in my speech on 19 February 2019 have actually now been directly addressed in this new Bill.
I said back then, and I quote, that: “extra resourcing will undoubtedly need to be devoted to administration … in addition to frontline care itself”.
I also referred to, and I quote: “the problems around (the) complexity of cases and the reality that modern case mixes are not always amenable to being reduced to and defined by a predetermined formula or equation”.
I am therefore especially glad to see that the Government have now specifically incorporated into this Bill some changes that acknowledge those concerns. I sincerely thank them for doing so, through the introduction of the ‘in-charge’ nurse or midwife and the ‘after hours co-ordinator’.
Those are very important changes, particularly for hospitals in rural and regional areas.
I might add that I did also raise, at some length, in that speech on 19 February last year the clear and urgent need for governments to address what I described as the enormous problem of the generally inadequate resourcing of aged care in Australia.
I added that the objective of “enhancing aged care should be a major priority of every Australian Parliament” – and that all governments should explore the opportunity to do more in this field.
It gives me no pleasure to observe just how fateful those words have proven to be in recent weeks and months in the midst of the COVID crisis.
One of the things I also said on that day was that, and I quote, “if we are talking about improving the ratios of health professionals and carers to patients, it is very doubtful that there is a greater need for this to occur anywhere in the system than in the care of our senior citizens.”
In the preceding year, the AMA had observed that, while bed number ratios for the general population had remained static in recent years, they had then plummeted to a 23-year low for Australians aged 65 and over.
All of what I said was very true then; it remains equally true now. So I would continue to urge all governments to improve the provision of aged care. This is so important and so critical to good government in any civilised setting. There’s no excuse, ever, for the neglect of our elderly citizens, and I would be horrified if – by now – there is anyone left in a senior position in government or in the public service anywhere in Australia who does not realise that.
Otherwise, only a small number of additional points of concern and uncertainty have arisen in the course of my scrutiny specifically of this new Bill now before us.
One of those is to do with the establishment of the new minimum qualifications for maternal and child health services.
I have a very special regard for the importance of maternal and child health. So I certainly don’t quibble in a broad sense with the Government’s stated aims here of enhancing the delivery of child, maternal and family centred practice and ensuring the availability of high-quality maternal and child health services.
In fact, the idea of establishing minimum qualifications for maternal and child health nurses is entirely sensible, in principle.
I say that with particular reference to the appalling events at Bacchus Marsh Hospital in 2013 and 2014 – from which time more than 100 troubling cases of stillbirths and neonatal deaths at that hospital have subsequently been identified by health authorities.
In turn, as part of the investigations into these cases, VCAT ordered in 2018 that one of the hospital’s registered midwives never practise again. It found that she had committed serious professional misconduct on at least 10 occasions (including in three cases that directly resulted in the deaths of babies) while she was responsible for patient care at the hospital.
Those cases alone raise some questions about why minimum standards and qualifications have not existed, until now, in this area of the law.
That said, though, I will concede that I am also left to wonder exactly how the changes in this Bill might fully deliver on that objective.
There are some particularly important questions for me about what the specific implications of this kind of change are, at many different levels, in training and resourcing.
Does this shift infer, for instance, that there have been longstanding and serious flaws in the teaching of maternal and child health nurses in Victoria? And, if so, what have they been – and how are they now being overcome and who is responsible for this, specifically?
One would presume that a raising of the bar for qualifying as such a nurse might also mean there will be less of these professionals entering the Victorian healthcare sector in the future – and it would therefore be valuable for us to know if this is likely to create new shortfalls in some parts of the system.
This is naturally an even more pertinent issue in rural and regional areas, to which it continues to remain so difficult to attract health workers at all, let alone those in specialist fields.
A second outstanding issue that I’d like to raise is another one faced by many rural and regional hospitals – and it’s the matter of delays in the appointment of guardians to certain hospital patients. Unfortunately, there are still too many cases where hospital staff are unable to discharge a patient because they are still waiting for the formal appointment to that patient of a guardian.
In these cases, the guardian is regarded as being needed to help oversee their lifestyle, their personal decision making and/or their recovery and subsequent care.
Often, there is a wait for a guardianship application to be processed through VCAT that is so protracted that it can last for several weeks and even a number of months. For the hospital concerned, this essentially obliges them to keep the relevant patient under their care for all of that time. Typically, they are also not publicly funded for that bed beyond a particular date.
I’ve spoken about this before in the House, specifically in an adjournment matter in August last year. However, it’s a matter that unfortunately still persists for some hospitals (and patients) – and clearly detracts from the time and the capacity of nurses on the relevant wards to provide full care to all of
the patients there. Furthermore, my understanding is that there’s no way of easily accounting for these particular circumstances in the application of their nurse-to-patient ratios.
And the final live issue for me in relation to this Bill, at a much broader level, is how the implementation of the ratios is currently being practically impacted (and will continue to be impacted in the future) by the ramifications of Victoria’s COVID-19 response.
I would certainly be keen to seek the Government’s latest reflections around the full COVID repercussions, as they’re now understood, both for current and future staffing and also for the financing of public hospitals around the State.
Back in June, I asked former Minister Mikakos in Question Time about those very issues. I did so especially as a means, on behalf of my constituents, of trying to understand how COVID preparedness and treatment efforts had practically affected the overall health budget, not to mention changes on wards and the likely redirection of funding from some specific areas of activity in hospitals to others.
Given the substantial acceleration that occurred again shortly after that, in July, of COVID cases in Victoria, these have all become even more important questions and issues now than they were then.
We know, especially from the developments in the aged care sector and also from the contraction of coronavirus by many health workers both in Victoria and other parts of the world, that this is an incredibly challenging time to work in those two sectors – and, indeed, in any care-related role.
I won’t delve too deeply into this issue for now but, along the Murray River, we have also experienced many problems in relation to the functioning of hospitals and staffing in the face of the COVID-inspired closure of the border between New South Wales and Victoria.
The sudden dislocation of dozens of specialists, clinicians and other frontline and administrative healthcare staff – who were, in effect, unable to cross that border for many days after the initial closure in early July – caused enormous upheaval at many levels. Not least for those hospital administrators trying to ensure there was a satisfactory minimum complement of staff, at all times, to perform procedures and to care for patients.
I envisage the Government will fully agree with me here that there will continue to be many really difficult, complex and challenging questions for hospitals around staffing and financing issues, as a consequence of this pandemic, for a very considerable time to come.
For now, I’ll finish this speech where I began it by reaffirming that Derryn Hinch’s Justice Party will – if it even proceeds to a division – be supporting this Bill.
We strongly endorse the intent of the legislation, albeit with some caveats around it in relation to a small band of outstanding issues that continue to be associated with its administration and implementation on the ground.