Second Reading
Danny O’BRIEN (Gippsland South) (11:35): I am pleased to rise to speak on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. Like previous speakers, I would like to acknowledge, firstly, that we are coming up to International Women’s Day. Though this legislation is not specifically about women, clearly most of our nurses and midwives are women, and I acknowledge the work that they do, including those in my family. Members of my extended family are nurses and midwives, including a number of my aunties and cousins, who the minister at the table, the Minister for Emergency Services, will be pleased to know are members of the Australian Nursing and Midwifery Federation. Some of them are quite strong members of the ANMF and give me a bit of grief on social media from time to time. I am talking to you, Aunty T and Nicky. I acknowledge all of those in the health services for the work that they do and thank them for the care that they provide to all of us each and every day. I acknowledge too that they have had a pretty rough time of it over the last five or six years and even prior to COVID, but through the pandemic times things were particularly tough.
I want to just take up the last point the member for Mulgrave was finishing on and highlight not just the member for Mulgrave but many members. I see the member for Pascoe Vale is here as well, so I will give him a shout-out too, given his commentary on the matter of public importance yesterday. There has been a lot –
Katie Hall interjected.
Danny O’BRIEN: The member for Footscray is desperately asking to be referred to. She knows that the Nat vote carries a fair bit of weight in Footscray and she likes me to give her a mention. Those opposite this week have often been talking about cuts and saying it is only the coalition that cuts. I have been quite astounded. Did they not see the CPSU on the steps of Parliament this week? Have they not seen the Treasurer’s announcement of 3000 jobs to go? Now, I am not arguing against necessarily some efficiency in the public service, but the hypocrisy of those opposite! Ask the fisheries department how they are going with cuts at the moment. Half of the fisheries officers in the state have been sacked in the last week or so by this Labor government, so it is a bit rich to come in here and say, ‘We build up our health services. We build up our public services. They only ever cut.’ You are the ones cutting right now. They have completely lost control of the budget because Labor cannot manage money, and that goes to an important point about this legislation on the nurse-to-patient and midwife-to-patient ratios.
We are not opposing this bill, as we have not opposed previous bills with respect to the ratios, because we certainly support trying to improve the level of care that is provided to Victorians and at the same time reduce the burden and the stress on healthcare workers, particularly nurses in our hospitals. The concern that we always have, which the government never seems to actually address, is the impact of that on hospitals and whether that is funded. It is all well and good to go and stand next to the ANMF and say you are introducing these ratios, but if you do not then fund them properly, what does that do to patient care throughout the hospital? What happens if the hospital goes broke? That is seriously one of our concerns.
This legislation is the third phase of the nurse-to-patient ratios promised by the government as an election commitment in 2022. We acknowledge that. It introduces higher minimum staffing levels in intensive care units, in high-dependency units, in coronary care units and in emergency departments at varying levels depending on level 1 and 2 hospitals. Again, this gets to the crux of what government is all about. It is about making decisions. We would all like to have our roads perfectly manicured and maintained. We acknowledge we cannot have that perfection. We would all like to have every kid achieving at the highest level in education, and so we put more money into teachers and into schools. We would all like to have no bad outcomes happen in hospitals – of course they do happen from time to time as a natural factor – but we have seen recently some significant issues, particularly in my neck of the woods at Latrobe Regional Hospital, with sentinel events that have been quite frankly out of proportion and a concern. The point I am getting to is: you could put the entire budget into some of these areas and that would lead to unintended consequences elsewhere, and so it is with this legislation. It is important that the government understands that if it is going to do this it needs to actually fund the hospitals to pay for it, because ultimately the hospitals have to be financially solvent, and it is a concern to us over time. I am sure if members of the government have talked to their hospital executives at any stage, they will have heard the concern about this in the past with previous ratios that have been introduced.
The government has suggested that it has allocated $101.3 million to implement the increased staffing levels, but it has not been able to provide where that is in the budget. I am reminded of a previous minister in one of my first Public Accounts and Estimates Committee attempts. The Minister for Emergency Services at the table might even remember, because she was there too. I asked where this commitment, which in fact was on roads, was: ‘Minister, where’s this commitment on roads?’ He said, ‘It’s in the budget.’ I said, ‘Whereabouts?’ ‘It’s in the budget, Mr O’Brien.’ I said, ‘Yes, but what specific line item? What section? What output is it in?’ He said, ‘It’s in the budget, Mr O’Brien,’ and we are sort of getting the same answer on this one. This money is in the budget but there is no line item for it, there is no detail, and that is the concern – that while it is absolutely great, and patients and nurses will welcome having more resources, it does need to be funded, and that needs to be provided.
We know that our health services are already under significant strain. We saw that last year. We saw the government have had to commit an extra $1.5 billion to keep the system operating. We know that many of our major hospitals and indeed some of our smaller ones are operating in deficit and struggling to pay staff and bills on time. So it is unclear to us whether the government is providing enough.
The second question with this is the workforce capacity. Anyone in the health system will tell you – particularly those nurses – that it is a struggle to keep them in the system and a struggle to attract them. I know the government likes to talk about how many nurses and medical professionals it has employed, but it is interesting. I last year did a little bit of research after the minister told us that there has been a 50 per cent increase, I think the figure was, in nurses under this government. That is nice to know. What I then had a look at is the Department of Health annual reports, and since this government came to power there has been an increase in the total workforce in the health department of 152 per cent and an increase in the budget for the health department of 74 per cent, but there has been an increase in senior executives of 425 per cent. I do not know whether that is executives who have got to calculate whether the nurse-to-patient ratios have been delivered or not, but if you wanted to know –
Vicki Ward: How many people? How many actual people?
Danny O’BRIEN: Well, it is a significant number. I can tell you that if I have got it here. It has gone from 39.5 full-time equivalent to 207.4, so it is a significant increase. If we were interested in actually delivering frontline services on the ground, we would be putting those sorts of resources into the nurses and into the doctors and health professionals in our system. And I would hope that perhaps the CPSU might be complaining and saying to the Treasurer that some of those executives should be on the chopping block early on before anyone at the front line is as well, because that is the sort of waste and mismanagement that I think we have seen under this government. As I said, the workforce capacity issues are still there, particularly for nurses and for midwives as well. Again, if you talk to your hospital CEOs and executives – and I know I do fairly regularly – it is always a challenge finding them. Particularly in rural areas it can be very difficult. But it is a challenge, and it is up to the government to answer that.
The shadow minister in the other place Ms Crozier actually asked in the departmental briefing which hospitals have not been able to meet the existing ratios, and that was taken on notice and we have not got an answer to it. We are still asking if there has been modelling done on what the impact on the broader health workforce will be of this initiative. Again, it is all well and good to say you are going to introduce these ratios; you have actually got to have the nurses and midwives to fill those positions. I am very happy to accept that there will be aspirations, but this is actually putting it in law, this is not an aspirational target.
Again I would like to thank all our nurses and midwives for all the work they do in keeping us safe and well and treating us in our time of need. But I do caution that this government have form on not actually funding these reforms properly, and I am concerned that they will do so again.