PRODUCTION OF DOCUMENTS

Written on the 3 September 2014

 

Mr JENNINGS (South Eastern Metropolitan) -- I move:    That this house --

(1) notes --

    (a) that in the past the coalition government has provided ambulance response time data by branch at the 50th and 90th percentile in response to freedom of information requests;

    (b) recommendation 5 of the Auditor-General's Access to Ambulance Services report that Ambulance Victoria publicly reports a comprehensive suite of response time indicators, including national measures of response times at the 50th and 90th percentiles and a breakdown of performance by region and locality; and

    (c) the outright refusal by Ambulance Victoria to provide ambulance response time information by branch or by locality, as it 'may unduly excite public controversy' ahead of the November election;

(2) affirms the privileges, immunities and powers conferred on the Council pursuant to section 19 of the Constitution Act 1975; and

(3) requires the Leader of the Government to table, by 12 noon, Wednesday, 17 September 2014, a copy of a complete list of ambulance response times for code 1 dispatches for the period 1 July 2013 to 30 June 2014 for each urban centre and locality and for each local government area, including --

    (a) the total number of code 1 instances;

    (b) the average time to respond;

    (c) the 50th percentile;

    (d) the 90th percentile; and

    (e) the proportion of code 1 incidents responded to within 15 minutes.

This is a fairly formal motion. It is a little bit information rich in terms of what underlies an example of complete hypocrisy by the current government in terms of its position on the release of ambulance information. The motion also expresses the need and desire of the community to have information that reports on the effectiveness of ambulance services in this state. Victorians' access to that information is being denied by this government and by Ambulance Victoria. Access is being denied consistently in the Parliament of Victoria and through freedom of information requests, which have led to a number of proceedings at the Victorian Civil and Administrative Tribunal (VCAT) requesting that the information be released in the public interest. The release of this information has been resisted time and again by this minister and by Ambulance Victoria. Victorians would be absolutely amazed at the hypocrisy that has been evident in the Minister for Health from day one of his administration.

I note the extraordinary explanations Ambulance Victoria has given as to why it should not release information which reflects on its capacity to respond to emergencies in the Victorian community. Ambulance Victoria claims that it is not in the interests of the organisation to release this information in case the community has a dim view of it, in case people think that they are being let down by the ambulance service and in case Victorian citizens decide not to renew their Ambulance Victoria subscriptions on the basis of the poor performance of the ambulance service.

This is quite an extraordinary response by this government agency. The Minister for Health, David Davis, has been extremely selective in his release of data and information about the performance of the health system, despite the hundreds of questions that I would estimate I have asked him during the life of this Parliament.

Time and again I have asked him to explain the performance of the health system, whether it be ambulance performance, emergency department performance, surgery waiting lists or responses by the government, and at virtually every turn the minister has resisted the opportunity to share any facts with the people of Victoria. He has been running away from what hospital performance data, annual reports of Ambulance Victoria and national reporting data on the performance of the Victorian health system say.

At no stage does the minister choose to debate or disclose to the Parliament and the people of Victoria what the evidence clearly says. The evidence -- given through national reporting, state reporting and the reports of individual agencies in Victoria -- consistently reflects a deterioration in the response times and reliability of the ambulance service and the hospital system in Victoria.

Time and again the state health minister tries to confuse the public by talking about the extraneous responsibilities of other players in the health field and trying to shift the blame to the federal Labor government, although he now finds it to be atrocious when the same type of criticism is directed at the budget decisions of the federal Liberal-Nationals government.

Minister Davis applies a completely different logic and set of mathematical assessment to the financial impacts of the previous federal government in terms of its support for the health system. On one occasion the federal Labor government reduced funding to the Victorian hospital system, and Minister Davis embarked upon a community campaign for a year. To this day he continues to blame the federal Labor government for a financial adjustment that had nowhere near the impact of the financial decimation of the Victorian healthcare system that has been perpetrated by the Abbott government in terms of the forward projections of money coming to Victoria for hospital expenditure.

That does not stop the minister trying to confuse the public about those issues. It has not stopped him trying to confuse the public about the failings and poor performance of Ambulance Victoria, about the paramedics themselves and about the union representing the paramedics. He tries to blame the poor performance on industrial relations matters rather than on Ambulance Victoria itself, the way in which resources have been allocated to that service and the lack of funding that has been provided to emergency departments, which means that ambulances ramp outside hospitals and cannot transfer patients in a timely way.

The minister chooses to ignore those structural and resource problems that he has not fixed. Instead he tries to confuse the community by saying that the failings of Ambulance Victoria are at the foot of an industrial dispute between the government, Ambulance Victoria and paramedics.

Time and again, rather than trying to resolve that industrial relations issue, the minister has chosen to go to war with the ambulance union, to abuse paramedics in a verbal way through public advertising, to criticise their work and to misrepresent the nature of the offers that have been made by the government through Ambulance Victoria in the name of fixing that dispute. He has spent, I think, close to $1 billion of taxpayers money on publicising the government's view and its spin on these industrial relations matters rather than on providing new ambulances, finding a solution to the industrial dispute and trying to foster a harmonious workplace and good working relationships within Ambulance Victoria. On every occasion the minister has chosen conflict.

He has chosen to withhold the relevant information. He has chosen to find dispute wherever he can rather than assuming responsibility for fixing the problems of the ambulance service and the hospital system in Victoria and delivering better outcomes for the Victorian community.

Acting President, you may be amazed, just as the chamber and the Victorian public may be amazed, to understand that the information I have sought through this motion today is in fact information that as far back as October 2010 the Auditor-General recommended be furnished regularly by Ambulance Victoria to the public in the name of transparency, accountability and maintaining the appropriate performance measures of Ambulance Victoria. Extraordinarily the shadow Minister for Health, David Davis, actually applauded the Auditor-General's recommendation to make that information available. He went on to make a commitment as part of the election promises of the Liberal Party at the time that that information would be released.

However, that has not been the enduring position of the government. In the early days of the Baillieu government, now the Napthine government, this information was released through freedom of information. The community did have a snapshot of the performance of ambulance services in the early period of the current government.

That policy of releasing this information changed quite drastically and remarkably, because the public could see for themselves what the effect was on ambulance performance under this government. The community could tell that ambulance services were failing them. The minister and Ambulance Victoria decided to have a change of heart and to contest the availability of the information and pursue withholding information at great length at the Victorian Civil and Administrative Tribunal.

Just so we are very clear about it, the fifth recommendation of the Auditor-General in October 2010 is:
  •     That Ambulance Victoria publicly reports a comprehensive suite of response time indicators, including:
  •     national measures of response times at the 50th and 90th percentiles
  •     a breakdown of performance by region/locality.
Recommendation 6 goes beyond that. The report suggests:

    That the Department of Health reports on performance for total case time, broken down by the elements attributable to the Emergency Services Telecommunications Authority, Ambulance Victoria, and hospitals.

I share the view of the Auditor-General that that information would be extremely useful, but at no stage in the four years since have we seen it. On various occasions we have seen the release of information under recommendation 5. That is unsurprising because of the response from Ambulance Victoria to the Auditor-General's report in 2010. I have a response authored by Associate Professor Tony Walker, ASM, acting chief executive officer of Ambulance Victoria at the time specifically in response to recommendation 5:

    AV supports the recommendation in principle, and will work in consultation with the Department of Health to develop improved public reporting of response time performance.

In accordance with the response from Ambulance Victoria and the promises made on 6 May 2010, the then opposition spokesman for the Liberal and Nationals parties, David Davis, indicated in a policy statement that the then opposition, now the government, would support the release of information on ambulance services, including ambulance diversions, ambulance bypass and early warning system incidents and the number of ambulance ramping occasions and ramping hours that had occurred at Victorian hospitals. That commitment was made in black and white by the then opposition and supported by Ambulance Victoria.

The Labor government recognised the value of implementing the recommendation.

We knew the information was available in that form because it was in the Auditor-General's report published in October 2010. If members of the chamber or members of the community want to see how ambulance services were performing in 2009-10, that information is shown in appendices A, B and C, which run from pages 57 to 82. Figure A lists the performance of ambulance services by response times, by metropolitan responding branch -- it lists all the responding branches -- and the number of incidents for all the services across Victoria at that time. Figure B identifies metropolitan code 1 response times by local government area. Figure C1 gives code 1 response times by urban centre population of 50 000 and over for the 2009-10 period. It covers all the local government areas and all the urban centres. That table runs from pages 73 to 82. As members can tell, the outgoing Labor government enabled the Auditor-General to not only collect information but to report on it, and the report features an extensive series of tables outlining the information being sought today.

It may well be of note to the chamber that the report also indicates the performance of the outgoing Labor government and the performance of Ambulance Victoria under Labor. If members look at page 11 of the report, they will see a table showing the statewide average response times for code 1 incidents during the life of the Labor government from 2004-05 to 2009-10. They will see that during that period the state average response time for code 1 incidents was about 101/2 minutes at the start of the series and at the end was about 12 minutes, which was well within the expected outcome for performance at that time. Based on the most recent information we have, they are response times that this government has never achieved and is in no trajectory to achieve.

On page 13 there is a table showing the percentage of code 1 incidents responded to within 15 minutes.

That trend series between 2004-05 and 2009-10 commences at a little over 90 per cent and ends at a little under 90 per cent, but there was consistently around 90 per cent delivery of performance in terms of responding to code 1 incidents within 15 minutes. That was the track record of the Labor government as recorded by the Auditor-General, and it was clearly demonstrated in the report. The report outlined response times that have never been achieved by this government or Ambulance Victoria since then.

Time and again we see the Victorian health minister rising to his feet, flustered and belligerent, to try to tell me, the chamber and the community that he inherited services that were in chaos. However, looking at the measures that I just outlined and that the Auditor-General outlined in October 2010, which was in the last two months of the Labor government, we can see that in the last six years of the Labor government the response times were consistently better than they are now.

Ambulance Victoria consistently delivered an emergency response which was in accordance with not only what the budget papers were expecting of it but also what the community expected of it. Response times were commensurate with the needs of the community, providing a greater level of support in the community.

Labor's track record in delivering ambulance services is the benchmark we should use to understand and appreciate the performance by the current government. If members have a look at page 128 of this year's budget paper 3 they will see that under this government the expected outcome for responding to code 1 emergencies within 15 minutes was 72 per cent. Under Labor, Ambulance Victoria response times remained constant and stayed within the recommended time frames and performance targets of the budget papers. We can see that even though there is a target of 85 per cent of calls to be responded to within 15 minutes, the last measure by this government showed the figure to be as low as 72 per cent.

That means that more than one in four calls are not responded to within the recommended time frame. It is a clear indication in the budget papers that Ambulance Victoria is failing.

We may find it extraordinary that the information I have sought to have tabled by the minister has been withheld bot one of the reasons could be that either the minister or Ambulance Victoria is trying to pretend that the information does not exist. However, it does exist. There have been three occasions during the life of the current government where this information has been made available to the opposition. It was provided on 3 August 2012, 21 March 2013 and 26 July 2013. In a few minutes I will run through what that information said. In essence it said that response times were getting worse in every locality and at every branch across the network of ambulance services. I will be able to report on that later.The sorry situation is that after the release of that information under FOI on those three occasions Ambulance Victoria decided to withhold it. It gave its reason for doing so to the Victorian Civil and Administrative Tribunal. On 18 August -- just two weeks ago -- the chair of Ambulance Victoria, Linda Sorrell, sent an extraordinary letter to the opposition. In it she outlines why this information is being withheld. I will read from that letter to the opposition which indicates why Ambulance Victoria wants to withhold the information. Linda Sorrell said:

    The publication of source data in an unaggregated form may unduly excite public controversy on an issue which is already attracting media attention and the subject of current protected industrial action by the Ambulance Employees Union ...

    There is clear potential for the source data to cause confusion as to both the required performance standard and Ambulance Victoria's performance against that standard.

    Ambulance Victoria is likely to be unreasonably disadvantaged if the publication of the source data further inflames the industrial campaign, the undertaking of which in turn affects efficient service delivery by Ambulance Victoria.

    The publication of location-specific response times is likely to unreasonably disadvantage Ambulance Victoria in terms of its business, commercial and financial interests if any location-specific response times act as a disincentive to current and/or prospective patients subscribing to ambulance cover in the areas which reflect greater response times.

Apart from the sheer audacity of those propositions, in terms of how Ambulance Victoria is acquitting its public interest obligations to the citizens of Victoria and accountability for its performance, I find it a fairly extraordinary failure to rise to what is clear public interest and failure to provide community members with information so they can form their own view about the effectiveness of this service and the government's support for the organisation or lack thereof. Ambulance Victoria and the government should revisit that extraordinary denial of this information.

I implore the chamber today to seek a mandatory requirement invoking the sanctions of Parliament. In fact that is something the government is very interested in doing today. Today the government is interested in invoking standards of appropriate parliamentary scrutiny and rigour. The government appears to be obsessed, in its self-serving, selective and capricious way, with imposing standards of parliamentary behaviour and performance, but it is not actually applying them to its ministers. It is not applying standards of public disclosure, accountability and consistency, and a flagrant hypocrisy is being demonstrated by one of its ministers.

Unless there is a road to Damascus conversion by all members of the government today and the government applies the same standards to all of us, I reckon there is a good chance government members will vote against this motion.

But if they rise up in the spirit of improving parliamentary standards, they will probably put their minister on notice and say, 'This information should be made available to the Parliament and the people of Victoria'. I look forward to any government member rising to that opportunity to show they have some standards of propriety and accountability. Let us see whether they can do it. Let us just see whether that can be achieved today. It is a good test for the Parliament this week.

The evidence suggests something from what the chair of Ambulance Victoria has said -- that is, that if this information was released, it would have an adverse effect on Ambulance Victoria's financial position. That does not ring true. I tabled evidence in VCAT hearings on the financial outcomes and financial positioning of Ambulance Victoria during the first two years of the current government, when its performance had deteriorated significantly. The evidence shows that the number of subscribers to Ambulance Victoria continued to rise.

The argument mounted by Ambulance Victoria was that if the public knew how badly it was performing, they would not subscribe, but that does not ring true.

In 2009-10 there were 967 967 subscribers. In 2011-12 there were 1 014 360 subscribers, and in 2012-13 there were 1 038 467 subscribers. Members of the Legislative Council and anybody who is listening to this debate will know that those numbers have continued to rise. That is a rising trend, with each year's subscriptions higher than the year before, while Ambulance Victoria's performance was going in a negative direction. Its performance was getting worse, but the number of subscribers was increasing. The argument that Ambulance Victoria raised that revealing the figures would have an adverse impact upon its subscriber base or its financial positioning does not ring true when you examine the facts, which can be obtained through the annual reports of Ambulance Victoria.

I will refer to another aspect. In cross-examination at VCAT Tony Walker was asked, even with a reduction in the number of subscribers, if somebody in Victoria used an ambulance, how would Ambulance Victoria make the most money from providing that service? He was asked if Ambulance Victoria raised more money from transporting a subscriber or a non-subscriber. The answer is pretty clear: you make a lot of money -- probably about 10 times the amount raised by transporting subscribers -- from transporting non-subscribers. One trip for a non-subscriber would make 10 times the amount of money earnt transporting 10 subscribers. If you are designing your business model to increase your revenue, you would want to reduce the number of subscribers. You would want to have people being charged 10 times the rate every time they used an ambulance.

The financial argument of Ambulance Victoria is tenuous if it is suggesting that it will lose subscribers. That is one issue. Even if Ambulance Victoria loses subscribers, it makes more money transporting people who are not subscribers.

In terms of the financial imperative, I would argue that it is a ludicrous proposition that Ambulance Victoria would be disadvantaged by the release of the information.

Indeed at some stage during the term of this government the CEO of Ambulance Victoria, Greg Sassella, was asked whether this information should be released. He was asked these questions by Neil Mitchell on his radio program, and Greg Sassella indicated a somewhat contradictory position on this subject. In 2013 he acknowledged the importance of the information sought through the FOI request, stating that the ambulance performance per branch is interesting information and is critical to some people. At one level he actually accepted the public interest argument that has been mounted by Labor, paramedics and members of the community that in fact the information is useful because it reflects on the quality of service and it is critically important to many patients across Victoria. Its importance was acknowledged by Greg Sassella in this interview.

But then he goes on to say, 'We don't need to release it in this level of detail through FOI because it's released in our annual report and other reports'. He said that it was not a secret.

There has been no annual report tabled by Ambulance Victoria in this Parliament that has included that level of detail. Not once have the level of detail and the information sought by this motion today been provided in either the annual report of Ambulance Victoria or the budget papers. I have a transcript of this interview available to validate my reporting of this issue to the Parliament, and in this interview the CEO of Ambulance Victoria sorely let down the public of Victoria by indicating falsely that the level of information sought by this motion is available in Ambulance Victoria's annual report, in the budget papers or through other formal reporting mechanisms by Ambulance Victoria. That is not the case.

It has not been the case apart from the information released during the life of the Labor government, the information made available and reported on in the Auditor-General's report and on the three occasions that Ambulance Victoria released this information subject to FOI request in the early days of the current government.

What did that information show when it was released through FOI? I reported to Parliament on 12 June 2013 on what the outcome was for the reporting period provided to the opposition on 21 March 2013. The information indicated deteriorating ambulance response times right across Victoria. On 12 June 2013 in a debate similar to this one, I put on the public record what the impact upon response times had been.

I remind the chamber that that information demonstrated that for Broadmeadows, code 1 response times had worsened during the life of the current government by 3 minutes. In Cranbourne response times were 3 minutes and 15 seconds longer than they had been before; in Essendon, 3 minutes and 22 seconds; in Footscray, 3 minutes and 26 seconds; in Frankston, 4 minutes and 22 seconds; in Gembrook, 3 minutes and 35 seconds; in Ivanhoe, 3 minutes and 54 seconds; in Kororoit, 3 minutes and 28 seconds; in Macedon, 4 minutes and 48 seconds; in Melton, 3 minutes and 33 seconds; in Narre Warren South, 3 minutes and 6 seconds; in Niddrie, 3 minutes and 20 seconds; and in Northcote, 3 minutes and 9 seconds. In Prahran response times had increased by 3 minutes and 17 seconds; in Richmond, by 3 minutes and 31 seconds; in Thomastown, by 3 minutes and 29 seconds; in South Morang, by 4 minutes and 3 seconds; and in Tullamarine, by 3 minutes and 37 seconds.

That is a snapshot of the metropolitan area.

It is replicated across regional Victoria. It is a clear indication of the deterioration of ambulance performance in an environment where most educated Victorians know that, when you are in an emergency or crisis situation and your health is on the line, every minute counts. For many medical conditions, every minute of delay reduces your chance of survival, your chance of a full recovery and your chance of successful treatment through the health system. Every minute counts.

At the same time we gathered information on the incidence of ramping that occurred during the first year of this government. In an environment where every minute counts, what did that information show?

This government had promised to remove ramping of ambulances and to increase ambulance response times, but as I indicated to the chamber on 12 June 2013 -- a year and a quarter ago -- the situation got worse. From the time a year and a quarter ago I reported to the Parliament how Ambulance Victoria was performing, Ambulance Victoria and the government have shut up shop and denied the people of Victoria this information.

With the information made available to us before they shut up shop we showed that since 2012 at Monash Medical Centre ambulances had been ramped for an average of 1294 hours a month. At Frankston Hospital they had been ramped for 1323 hours a month; at Dandenong Hospital, for an average of 1012 hours a month; and at the Northern Hospital, for an average of 1081 hours a month.The extraordinary amount of time that ambulances were sitting with their patients in car parks and waiting bays outside Victorian hospitals was a disaster in the reporting period that I shared with the Parliament a year and a quarter ago. It continues to be a disaster because we know Ambulance Victoria's performance and the community's experience have not improved during that time. This minister is very self-serving and selective about any information he releases, which is inevitably incomplete. When we have wanted to know the average response times for getting to a crisis situation within 15 minutes, the minister has on one or two occasions released one measure -- the 50th percentile. Why does he release only the 50th percentile? Because it is the one that measures the least; because he tries to pretend that is an average. He tries to pretend that it is in accordance with the budget measures, the community's expectations of performance and what is medically appropriate in terms of the timeliness of the response. He chooses to ignore all those issues and tries to confuse the community.

If any government member can refute any of the facts I have put on the record in the chamber today, I will acknowledge that. If any government member can refute any of the technical data and information that I have put on the public record as far back as June last year and again today, I will acknowledge that in summing up this debate. I sincerely doubt that I will be called upon to do so, because the track record of this minister and the people who are forced to represent him in this chamber time and again is that they are not charged with the relevant information. They are not charged with data, they are not charged with budget extracts and they are not charged with hospital performance data that can validate the position of this minister who operates in a very rhetorical, confronting and, in my view, mischievous way that misleads the public. He does not take responsibility for his portfolio and he fails under any good measure of public administration.

If the minister or any government member stands up to prove me wrong in debating this motion, if the minister comes into the house and provides this information, then I will congratulate him and anybody who is taking corrective action in relation to this issue. If the minister complies with the terms of this motion, I will congratulate him appropriately for the disclosure that the Parliament would expect of him, if he delivers. However, I am not expecting to have to do that because I am not expecting the minister to rise to the occasion and to the expectations of the Victorian community and deliver better ambulance and hospital performance.

The health system generally has deteriorated significantly under this minister's watch.

If in the last two months he has in government he comes clean on that, then maybe all Victorians will be in a better position to assess his effectiveness during the four years he has been in this portfolio and not assumed responsibility for fixing the things he said he would fix and delivering the things he said he would deliver.

 

 

Ms CROZIER (Southern Metropolitan) -- I am very pleased to be able to follow Mr Jennings in speaking to this motion. I will not outline the motion in detail as that has already been done this morning. I have been listening to Mr Jennings's contribution and I want to make some comments on some of the points he raised, particularly in the last few minutes of his speech, which were, quite simply, ridiculous.

I want to go to one area which Mr Jennings refers to in his motion and that is the Auditor-General's Access to Ambulance Services report.

This report was tabled by the Auditor-General in October 2010, under the previous government. Much is said in this report, which highlights the many issues Ambulance Victoria was facing at that time. It is quite scathing about the administration by and action taken under the former government. Let us not forget who was the Minister for Health at the time. It was the current Leader of the Opposition in the Assembly, Daniel Andrews, who clearly did a woeful job in that role. That was highlighted by the bungled amalgamation of the metropolitan and rural ambulance services and the risks that posed.

As someone who has an understanding of ambulance response times in regional Victoria, I am aware that the challenges patients and services in regional Victoria face are significantly different to those of metropolitan Melbourne. I am sure my colleague Danny O'Brien will have some comments to make in relation to Gippsland. He understands only too well the challenges facing his constituency.

I want to quote from the report. The audit summary states:

    There is ... a view that this perceived deterioration is linked to the amalgamation of metropolitan and rural ambulance services on 1 July 2008.

That is in direct response to the initiative undertaken by the former government. The summary goes on to say:

    The time between the announcement of the merger and its implementation was short and only limited funds were provided to systematically deal with any cultural issues.

    ...

    Ambulances are taking longer to respond to code 1 emergencies, with the worst performance since 2004-05 recorded in 2009-10.

    ...

    This points to unfinished work from the amalgamation, particularly addressing cultural issues that have persisted from Rural Ambulance Victoria, and in bedding down more sophisticated resource allocation in regional and rural areas.

The report goes on to talk about the findings in relation to the benchmark data on standard response times, stating that:

    Metropolitan areas continue to get a more timely service than rural regions.

    ...

    ... AV cannot realistically offer similar response times across the state --

but the Auditor-General says that it does attempt to work towards a similar level. I think that is a very valid and pertinent point to make, because one can understand the differences between regional and metropolitan services.

However, the report also states:

    AV is also facing increasing demands from higher caseload numbers. The ageing population and the increase in chronic disease are factors driving demand, with code 1 incidents rising by around 9 per cent across the state in the past three years.

That is a really relevant point. We are facing an ageing population with a corresponding increase in demand. There has been an increase in the incidence of chronic disease, as the report highlights, and that in itself brings challenges as Ambulance Victoria members have to respond to those issues which form part of their workload every day. It really is about that workload. Ambulance Victoria members do a tremendous job every day, but it is about getting an outcome for the patient they are attending. That is what our health system tries to do each and every day. It strives to get a positive or improved outcome for each patient.

That is exactly what we did. When we came into government in 2010 clearly there was a crisis in the health system, and we needed to fix that. The Auditor-General's report highlights just what we were facing in relation to the botched amalgamation of the metropolitan and regional ambulance services in Victoria. It highlights some of the issues the Victorian public faced.

I am not saying it is easy; it is difficult. It is challenging, as I have highlighted. The previous government, like this government, was facing an increasing and ageing population with those chronic health disease demands on it. Nevertheless the then Minister for Health, Daniel Andrews, the member for Mulgrave in the Assembly, did not provide any data to the Victorian public. As I said, data on the hospital early warning system was never released. Real-time performance data was never released. We know that time and again data was not released.

Members can go onto the government website and see data in relation to median time frames. Earlier I was looking at my iPad to find some of that data in relation to my area, whether that be for the Monash Medical Centre or the Alfred hospital or looking at emergency department status, statewide status, emergency care, activity with ambulance attendances or total emergency attendances.

This is all data that is provided by the Victorian health services performance website that we said we would create, which we have done. That is about improving transparency of data and providing the Victorian public with data. It is a vast improvement on what was provided under the Labor government, which did not provide data of this nature and refused to release it time and again.

As I said, when we are talking about ambulance response times and various other elements surrounding patient care it is about getting a better outcome. There is no doubt that the Victorian government is committed to improving transparency in the health system across the board. That is clearly being undertaken. The last few comments Mr Jennings made while winding up his contribution to the debate were just ridiculous. He should think about the capital expenditure this government has undertaken across the state and the number of hospitals that are being built or redeveloped. That means improved services for a growing and ageing population.

There are many more things that need to be addressed in relation to our health services, but -- --Mr Leane interjected.

Ms CROZIER -- Mr Leane, you would understand that in the area you represent the Box Hill Hospital redevelopment was delivered under budget and ahead of time. That is not something the former government can take credit for because it was absolutely hopeless at managing money and absolutely hopeless at managing projects. We saw that time and again with all its projects. I am not going to list them now, but members have heard the list before. I am just talking about what is really necessary here. The redevelopment of the Box Hill Hospital is a very good example of additional beds being provided through savings from good project management.

To get back to this area of transparency and outcomes for Victorians, in 2011-12 there was transparent planning and consultation for the Victorian health priorities framework and associated plans, including the metropolitan health plan for 2012-22 and technical paper, and, importantly, the rural and regional health plan for 2012-22 and the technical paper associated with that. These are some elements of improving transparency for Victorians. As I have already mentioned, there is also the hospital performance website, which is an implementation of one of the government's election commitments. That has been undertaken, and that data is available live as we speak. That is a far cry from never releasing real-time performance data under the former government.

If you look at that website, as I said, you will see that it covers the domains of access, patient experience, safety, efficiency and capacity.

It provides information on real-time hospital emergency department bypass, estimated median time to treatment for non-urgent emergency department patients and elective surgery median waiting times for selected procedures. It provides far more information than has ever been provided.

There are new measures that have been publicly reported for the very first time: rates of elective surgery hospital-initiated postponements; the number of emergency department mental health patients waiting longer than 8 hours for admission; the number of emergency department patients with a length of stay greater than 24 hours; ambulance attendances, which represents arrivals at emergency departments by ambulances; the proportion of ambulance patient transfers within 40 minutes; and the number of hours on the hospital early warning systems or queues. I reiterate that that data was never released under the former government. There is also the median waiting time for non-urgent emergency department patients.

From that list alone members can tell what this government has been undertaking.

In relation to some of the areas covered by Ambulance Victoria, I am pleased that the coalition government has undertaken to provide greater efficiencies and improvements and better outcomes for patients, especially in regional Victoria. One example of that is the thrombolytic, clot-dissolving drug that has been trialled and rolled out across Victoria. This has made an enormous and significant improvement to patient outcomes, and clearly that has been embraced by Ambulance Victoria. In a newsletter Ambulance Victoria speaks about research showing that being in remote locations and having variable access to hospital-based emergency and cardiac services delay potentially life-saving treatment. This initiative alone has resulted in a dramatic improvement in patient outcomes after cardiac arrest compared to what we have had in the past.

Another area I would like to speak about is in relation to the improvements this government has undertaken in terms of the metropolitan area, with additional resources available today. In my area of Southern Metropolitan Region, Bentleigh East has a new peak-period unit with six paramedics. Pakenham and Cranbourne have additional resources. Yarra Junction, Emerald, Mount Eliza, Endeavour Hills, Cranbourne North and Belgrave all have additional resources. There have been capital works in a number of areas. In Healesville a major renovation is being undertaken. It is currently in the design phase and is forecast to be completed next May. Rosebud, Lysterfield and Somerville will all have capital works improvements, and there have been significant ambulance improvements right across regional and metropolitan Victoria. I will not speak about other areas; I will leave them for other members to discuss, as I am sure they know what is happening in their areas.

I also commend the government on its announcement on 26 April of a $550 million investment in world-class ambulance helicopters. I believe these will be in operation around January 2016. This will be an enormous improvement, and it will bring about improved outcomes and benefits for patients across Victoria. Again I note that there has been a population increase, and clearly response times in regional Victoria are a lot more complex because of the geographic locations. This government has recognised the challenges in regional Victoria and put in place initiatives such as this -- and this is just one -- which will have enormous benefits to patients in rural and regional Victoria.

This fleet of new helicopters will have the latest in avionic technology. They are faster, bigger and can travel longer distances without refuelling. The new aircraft will be able to fly time-critical patients to Melbourne from communities more than 250 kilometres away in less than 1 hour. To have that ability to get a critical patient from such a long distance away into a major metropolitan emergency department in that time frame will improve outcomes. That is what we are really interested in -- better outcomes for Victorian patients and their having greater access. That initiative alone will enable better outcomes.I will now discuss other data that was released in relation to ambulance transfer times. We know there have been significant improvements to ambulance transfer times. The Victorian Health Services Performance Report released in April this year looked at a number of areas, including the work of the task force that was undertaken to look at ambulance transfer times.

We knew it was an issue. That is what the task force did. The number of transfers completed within 40 minutes is now 83.3 per cent, up from 78.6 per cent in the previous quarter and 77.4 per cent in the same period in 2012.

Specifically there are various areas -- hotspots, if you like -- that were having significant issues. A media release I am referring to has some really good examples of how significant the turnarounds have been. The Dandenong Hospital, for instance, improved its 40 minute turnaround from 67.2 per cent in December 2012 to 91.1 per cent in December 2013, and Frankston Hospital went from 59.8 per cent to 84.7 per cent. They are significant improvements, listed in the health services performance report. The report also went on to say that half of category 1, 2 and 3 patients are treated within 11 minutes, an improvement on the 12-minute median in the previous three months, and all category 1 elective surgery patients received their operations within the benchmark 30 days.

We can see from that report alone that there have been significant improvements. We know there is more to do. As I said, this is obviously a challenging area, but that is why we have been committed to providing data to the members of the Victorian public on a website so they can see what is available. In addition to that we are making improvements in enabling regional and rural Victorians to access major metropolitan health services, if required, through the delivery of world-class ambulance helicopters, as we have announced, and an additional 539 paramedics. That is also boosting our very important ambulance service, and that has gone along with a significant resource allocation -- $696.5 million in this year's budget, an increase of $132.4 million. This is something we are continuing to work on. We are delivering and increasing those resources.

It is also relevant that in 2009-10 the number of qualified paramedics was around 38.8 per 100 000 people and that in 2012-13 that number increased to 43.2 per 100 000 people.

That demonstrates what we are doing -- we are putting more paramedics on the ground to address those critical issues for Victorians. That is what this is about; it is about getting better outcomes for the people of Victoria.

The Minister for Health argued the case in terms of delivering increased funding -- and I know Mr Jennings talked about that and spoke about the Labor government and the financial impacts and Mr Davis's continued efforts. Let me say that Mr Davis led that charge on behalf of every health minister around the country, and he highlighted just what that federal Labor government did in ripping out $107 million halfway through a financial year. I am not going to labour the point -- pardon the pun -- but that had a significant impact on service delivery for those health services which had their budget ripped out from beneath them halfway, as I said, through a financial year. Mr Davis should therefore be commended for his action on that. He led the charge, as I said, on behalf of other health ministers, and that Labor government backflipped.

Nevertheless, we are playing catch up on that.

Our health services are doing a tremendous job, as are our paramedics and ambulance services. We are getting better outcomes for Victorian patients, and we are putting data on websites, something the former government never did.

 

 

Ms HARTLAND (Western Metropolitan) -- I will be brief because Mr Jennings prosecuted this motion very well in his presentation. The one thing I would like to add is that in all of these debates the Minister for Health -- who, as usual, is not here -- has refused to negotiate the paramedics enterprise bargaining agreement. He also demonises ambulance officers and their union, and he does not accept that they have a credible and reasonable case. I would have thought that two years into a major dispute with ambulance officers a health minister would use his time to resolve the dispute rather than demonise ambulance officers.

All the points Mr Jennings outlined are credible, and they go to the major problems we currently have with the ambulance service. Rather than resorting to blame, the government should sort this out quickly, because it is putting people's lives at risk.

 

 

Ms DARVENIZA (Northern Victoria) -- I am pleased to rise to make a contribution to this debate and to speak in support of Mr Jennings's motion. I agree with Ms Hartland that the Victorian government's long-running dispute with ambulance officers has not done it any credit. I believe it has led to very low morale amongst ambulance officers and within the ambulance service. In fact it has encouraged some ambulance officers to leave the service and even to leave the state to find employment elsewhere.

This government and the Minister for Health have spent an enormous amount of money -- just shy of $1 million -- on full-page advertisements proclaiming that the government has made a wonderful offer to ambulance officers and demonising them for not accepting that offer.

This is not a good use of just under $1 million of taxpayers money. If you asked anyone in the street how they think this money could best be spent in health, they would not choose these full-page advertisements. If you spoke to people who have called for an ambulance and have had to wait an exceedingly long time for it to come, or members of families or communities of the people who have died while waiting for ambulances, they would agree that this money could be much better spent on providing better health services and ambulance services for the people of Victoria.

The public will put up with a lot from the state government, and there are many things that they are unhappy about with this government. However, they will not tolerate substandard treatment for themselves or their loved ones. This includes the delivery of health services, whether they be community-based or hospital services, and ambulance response times.

Why is it that while the member for Hawthorn in the other place, Ted Baillieu, was Premier of this state response time statistics for our ambulances were available to the Parliament and Victorians, but they are not available now? Minister Davis, the current Premier and Ambulance Victoria will not make them available because response times are so bad. They are bad compared to when Labor was in government. My colleague Mr Jennings went through in some detail the Auditor-General's 2010 report entitled Access to Ambulance Services, which clearly sets out response times from when Labor was in government, and these can be compared to the most recently released data for this government.

The government and Ambulance Victoria will not release the data because the data is not good. They do not want the public or the Parliament to know what the response times are because they are concerned that if the data on local response times is revealed, subscribers to Ambulance Victoria will no longer subscribe. Ambulance Victoria does not want its ambulance subscriptions to decrease.

The government and Ambulance Victoria are also concerned that people will drive themselves to hospital rather than wait for ambulances. I am also concerned that people, in a state of high anxiety and in a medical emergency, will choose to put a patient in a car and drive them to hospital rather than wait for an ambulance because they fear what the response time will be.

It is not good enough for the government and Ambulance Victoria to say that because they have some concerns they will not release this data. The non-release of this data and information makes everybody nervous and concerned about whether an ambulance will be available when they need it. The Auditor-General and the Victorian Civil and Administrative Tribunal have recommended that the data should be made public, but Ambulance Victoria and the Liberal-Nationals coalition government have refused to do this. This is just not good enough.

As I said, I do not think it would matter who you spoke to in the community, they would all agree with me, Mr Jennings and this side of the chamber that this data is important and should be made available to the public.

Hiding response times simply erodes public confidence in Ambulance Victoria, the minister and the government. It shows that the Liberal-Nationals coalition government and the minister will not share information with the public or disclose it to the Parliament; rather, they choose to blame ambulance officers, the union, the industrial relations environment or the industrial relations system. It is simply not good enough. I believe the people of Victoria are sick of this ongoing dispute with and demonisation of ambulance officers by the Liberal-Nationals coalition government.

Ambulance Victoria is concerned that people will be frightened of using ambulances in areas where response times are the longest.

But the Liberal-Nationals coalition government and Ambulance Victoria are simply trying to protect themselves and hide the fact that not enough resources are going into our health system, particularly the emergency hospital system, to deal with the patients who are arriving in ambulances. They are simply failing, and they want to hide this failure from the public. However, the public has a right to know what the response times are and if in fact they are increasing.

The Liberal-Nationals coalition government, the minister and Ambulance Victoria have come under fire for saying that releasing the figures may unduly excite public controversy. It is as if they are saying, 'We're concerned that if we tell people what's going on, people will be concerned, when we know they have every right to be concerned. Therefore the action we take is to do nothing'. That is this government's position: do nothing, do not release the data or give anybody the information because it might be controversial, and it would not want anything controversial, particularly in an election year. It does not want any controversy around response times and certainly does not want people to know and understand that there has been an increase in response times, particularly where they are the longest.

The Liberal-Nationals coalition government, the minister and Ambulance Victoria are very reluctant to provide information to the public.

They do not want to give us information so that you and I will know just how long we are likely to have to wait for an ambulance in the areas we live if we should have a heart attack or if someone in our family should have a medical emergency such as a stroke or some other condition; they do not want us to have this information. I believe we have every right to have that information; the community believes it has every right to have that information. The Liberal-Nationals coalition government under the leadership of former Premier Ted Baillieu, the member for Hawthorn in the Assembly, believed we had the right to have this data, and therefore it was released.

What has changed? The only thing we can think of is that ambulance response times have increased -- they have got a whole lot longer -- and that is going to be of huge concern in the community. The government is saying, 'Let's keep people in the dark. Let's not tell them the truth. Let's not give them the data so they don't know what's going on'. It is not good enough.

This is not the way a government should operate. Regardless of what Ms Crozier said in her contribution regarding this government's response to health care and how it compares with that of the previous government, we know that when Labor was in government -- and we have seen it through the Auditor-General's report, which Mr Jennings went through in some detail -- response times were consistently better. Ambulances met the standards set by Ambulance Victoria consistently better under Labor than under the Liberal-Nationals coalition government. This is proven in the data we received when Ted Baillieu was leader, which is when we last had access to some of it. Now we cannot get access to any of it.

Over the last three years, since the Liberal-Nationals coalition government came into power, ambulance response times across the state have dropped from about 80 per cent to 73 per cent. This has happened in spite of targets of 85 per cent and 90 per cent being set. Those targets are not anywhere near being met.

In places with a population of more than 7500, for which the target is 90 per cent, the response times have fallen from 86.9 per cent in 2009-10 to 78.2 per cent.

As I said, the Liberal-Nationals coalition government has spent tens of thousands of dollars -- just under $1 million -- in advertising around the enterprise bargaining dispute with ambulance officers. It has taken two years. I do not know what is wrong with the negotiators on the government side. I do not know why they do not get industrial relations or why they cannot negotiate a settlement with the ambulance officers. I worked in industrial relations for many years and negotiated many an enterprise agreement, and for the life of me I cannot work out why this government and this minister cannot reach an agreement and they have resorted to wasting -- and I believe it is a waste -- just under $1 million on full-page advertisements in newspapers across this state getting stuck into our hardworking ambulance officers.

Even though the government treats our ambulance officers so badly, I do not believe there would be any member on either side of this chamber who would not agree that they do an excellent job. If you are in a medical emergency situation -- if you have a medical crisis yourself or are with someone who is having a medical emergency -- by golly, you want that ambulance officer there quickly and smartly. They do a brilliant job, and they are working under enormous pressure and duress under this government.

Ms Crozier said the state government -- her Liberal-Nationals coalition government -- can say a lot about its performance in the health sector, but ambulance response times and bed waiting lists are signs of a system breaking down. Regardless of what Ms Crozier says, if you look at hospital ramping times -- where ambulances are ramped up outside emergency services -- waiting lists, the number of beds and ambulance response times, you will know that something is not right in our health system.

If you speak to anyone who works in our health system, they will let you know that it is at breaking point.

Premier Denis Napthine cut $820 million from Victoria's hospitals. He has a lot to answer for with the current crisis right across our healthcare system, including what is happening with ambulances. The Australian Medical Association (AMA) said after this year's May budget that the Liberal-Nationals government had failed to acknowledge pleas from doctors for substantial and widespread improvements to the state's health system. The AMA's Victorian president, Dr Stephen Parnis, said ambulances were being ramped, hospitals are on bypass, there are not enough beds and the budget fails to consider the increased growth in demand. While Ms Crozier says, on behalf of the government, how much it has improved performance in the health sector, this is what the people on the ground are saying. This is what the AMA is saying about the lack of funding in the budget, and this is what its president has had to say.Paul Almond, the Ambulance Employees Australia delegate for Shepparton and Mooroopna, the area where my office is, said the argument is simple -- the goodwill of paramedics is what carries the organisation forward, yet emergency departments are struggling to take patients from paramedics in a timely manner, paramedics are being worked longer and their workloads are increasing.

Ambulances are increasingly being ramped at hospitals until beds become available in emergency departments. This takes ambulances out of circulation, sometimes for hours at a time. Ambulances sit outside emergency departments and are unable to get to their next jobs until the hospitals are able to take the patients. Yet this Liberal-Nationals coalition government determined that it would cut health funding by $826 million in its last budget.

The Liberal-Nationals coalition government should take the time to check out Code Red, the Value Our Ambos social media web page, because members of the public have expressed very strong opinions in support of our ambulance officers on that page.

This is a motion that deserves support. There is no reason for this data not being made available. It has been made available by previous governments.

It was made available by Labor when it was in government, and when Ted Baillieu was Premier his coalition government made some data available. There is no reason for this data not being made available now to both Parliament and the public so that we all know what the response times are across the state and so that we, as the public, are in a position to see just how well this Liberal-Nationals coalition government and Ambulance Victoria is going in terms of response times for emergency patients throughout Victoria.

Business interrupted pursuant to standing orders.

ABSENCE OF MINISTER

The PRESIDENT -- Order! Before we proceed to questions without notice, I notice that Mr Rich-Phillips is not with us today.

Hon. D. M. DAVIS (Minister for Health) -- I inform the house that Mr Rich-Phillips is absent on a family matter, and I note with thanks the understanding of the house.

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