Written on the 19 February 2019

19 February 2019

Second reading


Georgie Crozier (LIB)


MS CROZIER (Southern Metropolitan)

I am absolutely delighted to be able to rise and speak this afternoon to the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2018.

I say that because I was expecting to do so in the last Parliament, back in September, but I did not get the opportunity. Ms Mikakos: You shouldn't have filibustered then.

Ms CROZIER: Ms Mikakos interjects already, and I will come to that point in a minute. I find it extraordinary, and I have just had a guarantee from the Members interjecting.

Ms CROZIER: If I can continue, as I said, I am very pleased to be able to speak to this, because I wanted to speak back in SeptemberI will get to that point in a minute that the minister, who cannot help herself, interjects aboutbecause this bill is about those aspects that relate to patient care. It relates to both the nursing and the midwifery professions, which I have experience in. As a former nurse and midwife I feel very passionate about understanding legislation that directly affects that workforce and those people that work in the area, of which I know many and with whom I am in constant communication about various issues, whether they are constituents or whether they contact me about some piece of legislation like this that they feel will affect them.

What we do know in relation to this bill is it will provide a new rounding method for determining staffing in specified circumstances; stipulate how nurse-to-patient or midwife-to-patient ratios are to be determined in relation to mixed wards in which different ratios are otherwise applicable; change the nurse-to-patient or midwife-to-patient ratios applying to palliative care inpatient units, special care nurseries and birthing suites; provide for a nurse-to-patient ratio in relation to oncology wards, acute stroke wards, resuscitation beds in emergency departments and haematology wards; and enable, in specified circumstances, both nurses and midwives to staff a ward for the purpose of meeting staffing requirements for special care nurseries and postnatal wards.

This bill, as I said, is essentially what we debated in the 58th Parliament, but there is an important element. It might seem like a small amendment, but in fact it is actually a very important one.

If you want to rewrite history, Minister, it is important to note that, if this bill had been passed in the previous Parliament, then I believe it would not have delivered its intended purposeto enable those nurses and midwives who conduct their work around the state every day, 24 hours a day, to practise.

If I could just remind members, the debate came on at 11.30 at night on the very last sitting day of the 58th Parliament. There is history in relation to why the Parliament adjourned at midnight, and that was a decision of the house.

I think it is a bit cheap of the government to sort of ask to rewrite history.

I want to get on recordand I would hope that members of the union and others would actually understandwhat the house intended. I know that there was a letter written to the former shadow Minister for Health, Ms Wooldridge, and then a response to explain to the union just what went on.

I thought it was somewhat disappointing that the members of the coalition and the crossbench were highlighted in a communiqué from the Australian Nursing & Midwifery Federation in relation to this, which talked about us 'killing the bill'. In actual fact, if it had gone through, as I said, it would not have been as good as this bill is todayas it was intended to be. I think that is important to note, because as those people that contacted me said, they were in communication with the government for some time about their concerns about how it would affect them in their workplace and how it would affect them in terms of their professionalism and their ability to practise as midwives in special care nurseries.

So I am very pleased that that flawed bill from the last Parliament has been rectified and that those midwivesthose excellent midwives that provide the care in special care nurseriesare now recognised, because if it had got past at the death hour of the last Parliament, those excellent midwives who provide that care would have had their skills and experience not recognised, and I think that would have been shameful and would have caused unnecessary concern to many of them.

So I think it was, as I said, entirely disappointing that that came out and that the opposition and the crossbench were blamed for the government bringing on a bill at 11.30 at night Mr Gepp interjected.

Ms CROZIER: If it was such a priority, Mr Gepp Mr Gepp: Because you filibustered all day.

Ms CROZIER: No. Let's go back. There were seven bills listed on the sheet Members interjecting.

The ACTING PRESIDENT (Ms Patten): Order! Please, Ms Crozier, can we just continue without buying into this debate.

Ms CROZIER: Well, I think it is important to put on record the number of bills that were listed. If it was such a high priority of the government, then it should have been brought on earlier in the week and not at 11.30 at night. As I said, it is actually quite a coincidence that the government did stall at midnight, because it went back to the drawing board and actually rectified the flawed bill that it introduced into this Parliament. Just to reiterate why that is so important, it is because the Australian College of Midwives in October 2017 wrote to the minister and highlighted, in relation to substituted section 27 in the bill, that the generic term of 'nurse' resulting in midwives being excluded from the act would have actually had the consequence of excluding them from their employment in special care nurseries.

As someone who worked at the Royal Women's Hospital for 10 years, I know the dedication those midwives provide to some of the sickest and most vulnerable of babies, whether they are premature or term born with complications. They may be babies born to mothers who are withdrawing from drugs.

From my recollectionand I know it was some time agothe dedication and care midwives provide to those newborns is second to none, and I want to place on record again my support for them and the work they do, and indeed for all nurses across the state who provide tremendous care and support to Victorians.

I have worked in hospitals in metropolitan Melbourne and I have worked in hospitals in country Victoria, so I do have some understanding of the difference between the two and I want to come to my next point in relation to some of the issues raised with me around the concerns.

Whilst we all support appropriate delivery of care and for nurses to have a workload that meets the demands of those patients, various submissions in relation to this bill highlight that there could be some inflexibility for some regional hospitals, and I want to draw that to the minister's attention in the committee stage.

I just want to get back to what I was saying about some of the submissions that were made in relation to concerns raised. There was that element about having a look at flexibility to optimise care and the financial implications for the various health services and how that will impact on their ability to deliver safe patient care. I think we are all in agreement that we want toof course we want tohave safe patient care and allow our nurses and midwives to deliver that.

This bill goes towards enabling that to occur, but let us look at the bill to understand the consequences and if there are any restrictions on hospitals and healthcare services around the state. I will just return to some of the elements about special care nurseries, because this was raised with the minister.

The minister was notified of the concerns and she spoke about the patient ratio implementation task force that the government has set up, which was to provide advice on improvements to nurse-to-patient and midwife-to-patient ratios. That task force did provide those recommendations, but it is my understanding that they have never been made public. I think the public has a right to understand why that is the case, why those recommendations were not made public, what was the rationale and certainly how those final conclusions were therefore made in relation to this bill.

Did it take into consideration the submissions that were provided? I understand that around 80 submissions were provided in relation to feedback on this and trying to understand the implications. The last thing we want to do is to pass legislation that is going to hinder the ability of health services to deliver that safe patient care, especially in rural and regional areas.

Over the last few weeks the centralised banking system issue has been brought to my attention. Rural hospitals and health systems are really going to be impacted by a centralised banking system, which the government wants.

This will take away the enormous ability for those regional towns to be able to really focus on what they want to do, which is to provide care to those local communities and patients and people who rely on them so heavily.

That is one of the unintended consequences of a centralised banking systemit will impact on a lot of small rural and regional health services. Mrs McArthur is in the chamber. She and other colleagues like Ms Staley and Ms Britnell have raised with me their concerns.

Hospitals have spoken to them about these very concerns. What will this mean? What will the impact be on the local communities? How will that funding impact on the ability of those services to deliver their care? These are the sorts of decisions that we need to thoroughly understand. How will it be in small rural and regional hospitals?

How will they be able to deliver the services if they do not have flexibility? I know that this has been raised, and I will again raise it with the minister in the committee stage. The other issue I want to raise is the impact of the bill in relation to some of the decisions made by the Department of Health and Human Services and also the union's ability to actually undertake what they need to do according to the legislation. How will it actually be monitored?

How will it be provided to the minister of the day? How will decisions in relation to the publication of mixed beds in hospitals and the penalties that relate to that apply? How will those elements actually be undertaken in reality?

Again, I will be asking a number of questions about that in the committee stage, and I am hoping that the minister will be able to provide me with the answers that I require in relation to some of the reasoning as to why this is being undertaken. There are some other issues that have been raised, but I did want to speak to the comments made by my colleagues in the other place who raised these issues.

I particularly want to refer to the former member for Sandringham, Murray Thompson, who very eloquently laid out his concerns about the issue of section 27 and the midwives. He raised this issue with the then health minister.

The issue was brought to him by one of his constituents. That was months and months ago, so there was time for the government to actually amend the previous bill before it came into this house.

But, as I said, I think that the delay, even though everybody wanted this bill to get through the Parliament and accordingly we had those comments at the start of this debate, has meant that it really is a better bill now than it was in the last Parliament because that flaw has been rectified. I do not understand why the government would not rectify this in the last Parliament, but I am very pleased that they have done it now, and I want to say that I think that is a better outcome.

Those midwives and stakeholders that I have spoken to and the nurses who have contacted me also recognise that that is a better outcome for this bill in the entirety, so I think the chamber can be reassured by this bill as opposed to the previous bill. I am not going to make too much more of a contribution in relation to this bill because I have some questions for the committee stage and I know that there are aspects of the bill that other members want to raise. Can I say, again, that as someone who has worked in the public health system in both large metropolitan hospitals and in country hospitals as well as being a midwife in a large metropolitan hospital I do understand the complexities, even though that was some years ago.

I am sure technology has changed and that that will also contribute to what nurses and midwives have to deal with. I do understand that things have changed in relation to the length of stay, for instancehow long a patient will stay in a postnatal ward. But it is those elements around how a midwife can actually understand how a postnatal patient, a woman who is in postnatal care, can dramatically change in a matter of minutes.

It can be a very dangerous situation if a woman has a postpartum haemorrhage or equally in the antenatal stage if there is placenta praevia or spontaneously ruptured membranes at a premature stage.

You can have some very significant health implications, and the midwives who are training and accessing their courses have that specialised understanding and care. I think that is what the issue was here in relation to their concerns. It was not recognised how that would apply in this bill and how it would apply in the real world when you have got nurses looking after postnatal patients.

I certainly know from my experience of working in a country hospital that the nurses did assist the midwives in looking after those women that came in and had babies, and that was absolutely fine for those assisting, but it was the midwife who ultimately understood what was occurring and had that specialist knowledge and training. There are different avenues since my day, since when I trained.

I trained under the hospital system both for a general nurse and midwife, and there are different avenues now, so it is giving people more options. But equally, that expertise and experience needs to be recognised and understood. I think those patients in the postnatal period also need to have the understanding that they do have the specialist care that they require should they become very, very ill.

As I said, I know that other members want to speak on this bill. I am pleased that we have got what I believe to be a better version of what was introduced last year. I am pleased that those elements that were missing in the last Parliament have been rectified.

I know, as I said, that those midwives and nurses that I have been in contact with are reassured by that, and they are looking forward to the passage of this bill.



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