Thursday, 28 November 2024

Drugs, Poisons and Controlled Substances Amendment (Paramedic Practitioners) Bill 2024

Second reading

Debate resumed on motion of Natalie Suleyman:

That this bill be now read a second time.

Emma KEALY (Lowan) (12:02): The irony is that today I need some good drugs in my system to help battle this upper respiratory tract infection that I have, and I look over the table and I see the Minister for Agriculture also wiping her nose. We have all been hit hard just before Christmas, and I would encourage everybody over this Christmas period to look after their health. It can be a time when people do push themselves very hard in order to catch up with their social life. Make sure that you do look after yourself. Particularly take extra care on the roads – we know that it can be dangerous over this period; people drive further distances on unfamiliar roads and they are not quite sure where those potholes are, and they drive for a bit longer than they should. So to all those in the chamber and in the community, please take care this Christmas and new year, and we look forward to being able to come back here in the new year and to being able to continue into that third quarter, as we like to put it, of our four-year terms and continue to stand up for Victorians. In terms of the Nationals, we will always fight for rural and regional Victoria.

This bill, the Drugs, Poisons and Controlled Substances Amendment (Paramedic Practitioners) Bill 2024, is, as it says, in relation to establishing a legal framework for paramedic practitioners and authorising those that have completed a prescribed postgraduate qualification to be sent out to lower acuity patients and prescribe medications or other treatments without the need to be transported to hospital.

This is a concept that has gone back a very long period of time. The use of practitioners in healthcare settings is probably most well known around nurse practitioners, and it would be almost two decades ago that we were talking about nurse practitioners as a way to be able to save primary health care in rural and regional parts of Australia. Unfortunately, we have not seen enough nurse practitioners trained up. There have been challenges around ensuring that the scope of practice approvals is consistent with what the needs are for the local community, so it can be very difficult for nurse practitioners to move from place to place, and just generally I think there have been challenges that were unforeseen around attracting nurses to do another qualification. Often nurses who have been in the industry for a really long time are wondering, ‘Do I look towards staying in my current role? I’m already in a senior position. Do I want to go back and do more training?’ It would unlock of course a different scope of practice, a different level of work that they could do, a new challenge in their career. Or do they look at doing what they do? And they do it very well, whether that is in a hospital setting, in a community health setting or in other businesses – it might be a medical clinic or out in the community or through disability or ageing.

Our nurses do a fabulous job, as do our paramedics and everybody who is involved in the health system. We know the past four years has been a very, very challenging time to be involved in health care, particularly in Victoria. We are still, I think, feeling the impacts of lockdown through the impact on people’s mental health, particularly younger people’s mental health, They are still trying to relearn a lot of those social skills of interacting with other people, looking people in the eye and being confident within themselves to achieve things out in the big wide world. Even things like playing sport or a musical instrument, being artistic – these are things that a lot of younger people are finding a challenge. If it may stray a little bit, I was speaking to someone who owns some McDonald’s restaurants in my side of the state. Even McDonald’s is finding it very, very difficult to attract young people to work in that setting. Their view is that this is directly related to the impacts of lockdowns on young people’s ability to engage with people face to face rather than through a screen. It is a massive challenge that we have, and it is important that we are fully focused on acknowledging there is an issue and then putting things in place to make sure that we can address it and best support young people in our community.

This bill proposes to amend the Drugs, Poisons and Controlled Substances Act 1981 to establish paramedic practitioners as a class of registered paramedics and to authorise paramedic practitioners to obtain, possess, use, sell and supply certain substances. This is very much around ensuring if you have got paramedics, when they go out to attend a 000 call or they are in the community they have the ability to provide and dispense drugs which otherwise they would not be allowed to do. This is a really novel approach; it is great to see that Victoria is doing this. It is something that has been trialled in other places around the world. It is looking at how we can have a more integrated health system where people who are in our communities who have fabulous education and qualifications behind them and extensive experience are given just one additional piece of the puzzle in how they can deliver health care to more people.

If the government can get this right, it could result in people attending emergency departments less often. If there is something that we do need to see, it is that we make sure that there are strategies in place to stop the ramping that we are seeing in hospitals, to stop the long wait times for people to be able to get care in an emergency department, to stop the bed block that we see in hospitals where all of the beds are full and therefore nobody can be admitted from emergency, which means that nobody can be seen in emergency, which means the ambulance is parked out the front with somebody on board and they are getting treatment in the back of an ambulance. That then takes away the opportunity to have ambulances on the road to attend to 000 call-outs. It all cascades and it all fits together.

While this certainly will not fix those issues, I think in the minister’s second-reading speech there is a reference to the paramedics who are currently undertaking the additional training that is required. It is a very, very small number of people. At the moment there are 30 students who started their training in February of this year. There is another lot who are looking at going through this coming year. Every year there will be an intake of students. I do question whether the capacity of the training program will be able to meet the demand or the aspirations that the government has for paramedic practitioners in the community to take off all of that pressure that we are seeing, where every single point of our health system is at breaking point.

If you think about it, if you have just one team who are focused on being paramedic practitioners and offering this service, if it is going to be a 24/7 service – let us go very, very baseline and minimalistic here – there are three 8-hour shifts a day. We know there will be a bit of duplication in there as well. With seven days a week, that is 21 shifts you have to cover. You need at least five staff to be able to do that.

When you are only training 30 students who are entering the course, you do not know how many will finish the course and you do not know how many will end up practising after they finish the course as well. It is a very, very limited scope of how this is going to be applied. It is not going to stop the health crisis that we see in Victoria. It is a small piece of the puzzle. At least it is something – it is better than nothing – but it is certainly not going to be the be-all and end-all.

We know that there are other opportunities to utilise the health professionals in our community, and I will speak more to those later in my contribution. I think that it is very important that all parts of the health system and all of our professionals are respected for the skills, knowledge and qualifications that they have, also their experience, and that we look at these novel approaches to be able to unlock them. But we also have to ensure that there are sufficient resources provided to individuals so that they are able to train to get this additional certification if they choose to follow this pathway and that they are remunerated appropriately for taking on these additional skills.

We need to make sure that when we are looking at these types of programs, we are not just looking at such a small number of practitioners that are a very, very small number of people. Most likely just people in Melbourne will be able to reap the benefits. We need to make sure these types of programs are available in all corners of the state, because when it comes to access to doctors, when it comes to access to 24/7 support, whether it is through urgent care centres or bush nursing centres in the further reaches and less populated areas of this state, there often is not a choice, and in fact you have to travel at least a hundred kilometres or more to access support. I actually think these sorts of models, whether they are around paramedic practitioners or community paramedics, are something that should be targeted for areas where there is the least access to general practitioners and to that other, as it was referred to in the minister’s second-reading speech, lower level, lower acuity of people, who simply need to access some medicines either to keep an existing condition well managed or, when you are sick like me, to access some antibiotics to get on top of that illness before you get very, very sick or you share it with everybody in your community or your parliamentary team.

I can see that the government have an idea around this. It should be explored, but it simply does not go far enough to be able to make the difference that has been stated. I think that the Labor government have drastically overstated what the impact will be of this paramedic practitioners bill. I know that my words there will probably be twisted around. That is not to say that it is not a step forward, but let us see the government invest properly in this and provide the appropriate resources to paramedics so that they can access that additional qualification and be appropriately remunerated and so that these models can be put in every corner of Victoria, not just a couple of services around Melbourne, where there is a much higher density of general practitioners than anywhere else in the state.

Going through the main provisions of the bill, clause 1 establishes paramedic practitioners as a class of registered paramedics and authorises them to obtain, possess, use, sell and supply certain substances. Those substances, because this is part of the drugs, poisons and controlled substances amendment, are medications of course, so that will enable a paramedic who has additional qualifications and has an approved scope of practice to dispense certain drugs. They will be able to provide those on the ground in the community. Clause 4 defines a paramedic practitioner as:

… a registered paramedic who –

(a) has completed a prescribed postgraduate qualification; and

(b) satisfies the prescribed experience requirements …

This qualification is completion of the Master of Paramedic Practitioner delivered by Monash University. It is fabulous that Monash have worked up this training program, this qualification, the Master of Paramedic Practitioner. However, one of the limitations that we experienced with nurse practitioners was that there simply were not enough places available to undertake that additional level of qualification across Victoria; in fact for some period of time you could only achieve that qualification through Queensland-based universities.

We need to ensure that this is a model that can be taken up by other universities, and it may be that the government is required to provide support to universities, whether at a state level or a federal level, to work up those qualifications so that there are further courses available. This of course opens up choice, and if we can ensure that there are training opportunities in rural and regional Victoria, we are more likely to see rural and regional paramedics take on this additional qualification and the studies associated with that to be able to deliver these services in the communities where they currently live, where they are currently paramedics. That is very, very important, and I would encourage the government to look at how we can expand the number of places available not just through the masters degree but also for other universities around the state.

Clause 5 allows any paramedic practitioner to obtain, possess and use, sell or supply a schedule 2, 3, 4 or 8 poison. Again, that is a limitation. It is not anything that they are distributing, it is limited to approved poisons. Of course anything that is one of the approved poisons, they also have to be TGA-approved and the like, so there is no question about what type of drugs these paramedics will be able to dispense or provide. Schedule 2 and 3 pharmacy medicine, or pharmacist-only medications, include local anaesthetics and analgesics that are commonly referred to as over-the-counter medicines. This is important for people who are in pain or who have suffered a higher level injury but something that does not require hospital support.

At this point I would like to reflect upon one of the biggest injuries that we have that probably requires analgesic and wound treatment, and that is accidents on farms. We have seen too many farm injuries right across the state this year. Certainly in my electorate of Lowan we have a high density of farms, and unfortunately this year we have been hit really hard with on-farm deaths. They are not through lack of experience. It is certainly not through people who are cowboys or do not know what they are doing. These are simply things that have happened which have had absolutely tragic outcomes, not just for the individual and their family but people are still talking about some of the people who have passed away this year. We have had quad bike accidents, we have had vehicle accidents where people have been crushed, we have had horrific things happening on farms. Farming is a fabulous profession. It is very dangerous because of the unstable terrain that we work in, the heavy machinery and equipment that we utilise. There is so much variety in what you do on a day-to-day basis. There is a level of fatigue because during harvest and during other times such as sowing or shearing people are working very long hours and are fatigued. But we are not making a dent on improving farm safety.

I would like to acknowledge Ross Johns, who has been a passionate advocate for farm safety improvements, not just in Victoria but nationally. He is very keen to set up a similar resource to support a reduction in on-farm deaths as we see in the mining sector and to get the agriculture sector to come together to achieve that. I really commend Ross for his work. Ross is driven by the fact that his best mate Mick Morcom was killed in an on-farm accident earlier this year. I pay my respects to Mick, who was a fabulous bloke and gave so much to the community, and I also pay credit to Ross, who is certainly ensuring that he has no more mates dying on farms. It is an absolute credit to him.

Schedule 4 prescription-only poisons include local anaesthetics, antibiotics and stronger analgesics, such as Panadeine Forte. Schedule 8 is controlled drugs that require strict legislative controls, such as opioid analgesics like pethidine, fentanyl, morphine, oxycodone, methadone, buprenorphine, benzodiazepines and ketamine. There are a whole range of different drugs that paramedic practitioners would be able to supply. They will have the relevant qualifications to understand how this will impact on the individual and what the dosage that is appropriate for that individual would be. We all metabolise drugs in different ways and at different speeds. When I was at Healthscope Pathology many, many moons ago now, there was a lot of genetic work that they were doing in terms of the rate of conversion of drugs by individuals, which would help dosing of some medicines like warfarin, which is used as an anti-clotting agent.

It is a very skilled science to understand dosing, to understand medicine interactions that can be damaging to the kidneys or liver or can cause much more serious outcomes, and so while it is important that paramedic practitioners have those skills and qualifications, they will need the experience and they will need strict guidelines about the usage of those medicines as well.

Clause 10 enables paramedic practitioners to access the monitored poisons database, which is SafeScript, which contains records of patients’ prescriptions and supply history for high-risk medicines. This is aimed at facilitating safer clinical decisions and preventing the misuse of high-risk medicines and drugs of dependence.

I have spoken in this place on many occasions about SafeScript. It can be a fabulous program, but we have not yet seen from the Labor government sufficient support for pharmacists and for GPs to be able to understand what to do when somebody is flagged as having too much of a medicine dispensed or if they look like they have an addiction issue. There are not enough supports in place to be able to refer somebody to rehabilitation or treatment, because there are no places available. There are about 5000 Victorians waiting for drug and alcohol treatment on the waitlist today. It is an enormous number of Victorians who cannot access the support to try and get them off these drugs, and many of them are prescription drugs. They are incredibly dangerous, and they are incredibly addictive.

I also would like to take a moment to acknowledge the work of John and Marg Millington, who lost their son Simon to a prescription medicine overdose. I have told this story many, many times. They are close friends of mine. It was initially a commitment by the Liberal–Nationals government in the lead-up to the 2014 election – in fact 10 years ago; I am celebrating 10 years in Parliament, that I have been in this place, this week – and I think that was probably the first moment during the election commitment period when you make those promises to the public over what you will do in government. I am very proud that we were able to deliver that even in opposition, and that is something that is a fabulous program, but without the supports it cannot achieve the full outcomes and aspirations of what SafeScript should be able to provide. We need to be wary that this paramedic practitioner model is not used as an alternative to work around the SafeScript flagging system.

There are many aspects of course of the health system which are really under pressure at this point in time. We can look at different models which are available, and I would encourage the government to look at these and consider expanding what they are doing with paramedic practitioners and to expand it to other models where we can utilise highly skilled medical practitioners who are based in rural and regional Victoria, where there is a need and underservicing of people’s health needs. But we have got people who are also underutilised because of their role.

I would like to particularly acknowledge the work of Community Health First and ARRCH, which sits underneath that. It is the organisation which represents community health organisations across the state. Community health organisations really punch above their weight. They take a very, very small amount of money and they make sure that people who have diagnosed chronic disease are well supported, and they also help to make sure that people are well in the community. They take so much pressure off the system. They take so much pressure off hospitals in particular and GPs. It is something that we should see more investment in, and what Community Health First are looking for at the moment is a really small amount of money. They are looking for just $7 million to expand their community paramedics model, and this is something that has been enormously successful up in the Sunraysia area – the tropical north, as my friend the member from Mildura would say. This very small amount of money, $7 million, would avoid 7000 emergency call-outs. Seven thousand emergency call-outs would be removed, and 2300 emergency presentations would be avoided. This is a very, very small amount of money when you look at the entirety of the health budget. It is something that ARRCH and also Community Health First have been pushing for for a long time. In fact I have got a document here that goes back to 2023. It is their budget submission for last year. This ask is repeated this year. I encourage the government this time, when they are looking through the figures, to consider investing in that fabulous program.

The second thing I would like to highlight to the government that is a way that we can take pressure off the overburdened health system is to ensure that pharmacists are granted a full scope of practice. At the moment we have small steps in Victoria towards having pharmacists being allowed to dispense certain drugs. The ones that we hear about most often are treatments for UTIs and the pill, which was the commitment that Mary Wooldridge made when she was the shadow minister for health, but there are a range of other medicines that pharmacists could dispense quite safely. We have seen it take place in other areas and other states across Australia, and now Victoria has fallen well behind. We should not be the last to implement and an expanded scope of practice for pharmacists. They understand the drug interactions; that is what they were trained to do. They understand when drugs are appropriate and when they are not. When we have a limited number of general practitioners in the wider community and when we know that the lack of treatment for certain conditions can lead to hospitalisation if you do not deal with it appropriately and quickly, then I cannot see why you would not go ahead with supporting the Pharmacy Guild of Australia in encouraging and providing the opportunity for pharmacists to have a full scope of practice in exactly the same way that we are seeing with this legislation today. Paramedic practitioners can have an expanded scope of practice to dispense drugs directly and to see when that is needed, and pharmacists can do the same. I commend the Pharmacy Guild of Australia for their advocacy around that. Victoria has fallen behind; we need to catch up and we need to utilise these fabulous health practitioners for all of the skills, knowledge, qualifications and experience that they have.

We know that the health system needs help. I am in a region where we have suffered the impacts of Labor’s forced amalgamation of health services into Grampians Health, which is managed out of Ballarat. I cannot explain how devastating it has been for our health staff in particular to have managers that are a couple of hundred kilometres away and totally detached from decision-making and the problems that are on the ground. It has really hit their morale hard, and they have lost a lot of fabulous staff. We currently have a situation where the linen service machines are all broken down. We have got laundry staff who are travelling 2000 kilometres a week to do the laundry from Horsham at Ballarat hospital. We have got situations where anaesthetic machines are past their end of life and the foundation are being leaned on to replace anaesthetic machines that should be paid for by the state government. We have had devastating losses of staff and expertise. We still have not got a dental service in Edenhope – the first thing that Grampians Health did was shut the dentistry service in Edenhope –

Michaela Settle: It was voluntary.

Emma KEALY: It was not.

Members interjecting.

The ACTING SPEAKER (Wayne Farnham): Members will come to order.

Emma KEALY: And I note the rumours at the moment that the board chair has been sacked and replaced. I understand they had a new board chair take over the meeting last night. This is just a small snapshot.

Members interjecting.

Emma KEALY: I can hear the Labor members who are laughing in the background about this. It is no laughing matter when people cannot health care at home –

Michaela Settle interjected.

The ACTING SPEAKER (Wayne Farnham): Member for Eureka, you are not in your right seat.

Emma KEALY: It is inappropriate –

Steve Dimopoulos: On a point of order, Acting Speaker, the member on her feet is impugning the members on this side. They were not laughing; she should at least be more honest about the characterisation of what their contribution was.

The ACTING SPEAKER (Wayne Farnham): There is no point of order. The member will continue.

Emma KEALY: The minister at the table might not like the fact that Labor have completely destroyed health in my part of the state, but it should not be a surprise, because they have destroyed health care right across the state. Our healthcare system in Victoria has gone from the best to the worst in Australia, and it can only be described as appalling how the Minister for Health has handled this issue. There is no acknowledgement there is a problem, even though it is obvious to everybody when you cannot call 000 and get someone to answer the call, when people are dying on the front lawn waiting for an ambulance for hours for different conditions, when ambulances are ramped up outside our public health service for hours and hours and hours, when you have even got the ambulance union calling for an inquiry in the Parliament to understand what issues are going on, when you have got emergency departments who are so stressed and overwhelmed that there are people being treated in the corridors – a disgraceful situation – and when you have got bed blocking.

In fact just this morning one of my friends sent me a message that their best friend’s partner has been waiting for over 18 hours –

Members interjecting.

The ACTING SPEAKER (Wayne Farnham): Member for Lowan, could you resume your seat for a minute. Member for Melton, member for South-West Coast: stop. I want to hear the member for Lowan. That is enough.

Emma KEALY: When you have got somebody in an emergency department who is having an acute psychotic episode – I think half an hour ago a doctor finally saw them after an 18-hour wait.

Danny O’Brien interjected.

Emma KEALY: Eighteen hours with an acute onset. They have schizophrenia resulting in acute psychosis and they were waiting in an emergency department for 18 hours, and you try and push back? Labor members in here are shouting at me saying that there is no health crisis in this state – it is absolute rubbish. Listen to the members of your community. Listen to your constituents. Look at the statistics. Ambulance response times are terrible in this state. Health outcomes are terrible in this state. The cuts to health care by the Labor government are appalling. We see over and over and over the impact that the Allan Labor government has on Victoria’s health system, and it is Victorians that are paying the price. They are paying the price in the most horrific way – absolutely unacceptable.

It is all very good for the Labor MPs in here, who I am sure all have private health insurance; they do not have to worry about that. But you know what, it is the Victorians who cannot afford private health insurance in this cost-of-living crisis who will pay the price the most. The people who do not have choice, the people who Labor purport to stand up for at every single step, are the ones that Labor always leaves behind. They always leave them behind. Under Labor and under Jacinta Allan we see a health service in absolute crisis, and Victorians are paying the price.

Michaela Settle: On a point of order, Acting Speaker, correct titles, please – the Premier of Victoria.

The ACTING SPEAKER (Wayne Farnham): I think the member has finished her contribution.

Steve DIMOPOULOS (Oakleigh – Minister for Environment, Minister for Tourism, Sport and Major Events, Minister for Outdoor Recreation) (12:32): It is a real pleasure to rise on this bill. I was going to start with a different point, but I am going to start by saying you cannot trust the Liberal–National coalition in Victoria to say anything that resembles the truth – not one clause in one sentence. The louder the member for Lowan’s voice gets, the more she departs from truth and goes into fiction. That is the reality. This is a person who knows very well that her party in government closed hospitals in Eildon, in Koroit, in Mortlake, in Red Cliffs, in Macarthur, in Clunes, Birregurra, Lismore, Elmore, Waranga – should I keep going? They closed a swathe of hospitals.

Emma Kealy: On a point of order, Acting Speaker, the minister has strayed from this very narrow bill about paramedic petitioners and has failed to mention the hospital closures in western Victoria under his watch.

Michaela Settle: On the point of order, Acting Speaker, the minister was being entirely relevant talking about hospitals, which we just had to listen to in the contribution from the deputy.

The ACTING SPEAKER (Wayne Farnham): I will rule on the point of order now. The minister was responding to a previous contribution, and I am sure the minister will come back to the bill very quickly.

Steve DIMOPOULOS: Thank you, Acting Speaker. I was responding to the mistrust by the community of the Liberal–National coalition in Victoria. In her debate the member said that the health system is at breaking point. Then she said it is in complete disarray and crisis. Absolutely there are always tensions in health services. You do not leave gaps in capacity in such a busy portfolio, nor in education and health; you respond to the needs of the community at the time they are presented. Let me give you the real truth, because you will not hear it from the member for Lowan. The real truth in Victoria is we have the longest life expectancy nationally. You will not hear that in the mistruths from the Liberal–National coalition, including the member for Lowan. The other truth is we are the only state or territory where all category 1 surgery patients are treated on time – the only state.

The ACTING SPEAKER (Wayne Farnham): Through the Chair.

Steve DIMOPOULOS: We are the safest state to have surgery, with the least number of adverse events and the least number of readmissions of any state. This is not a Victorian government report; this is a report from Canberra, the report on government services. It is a national report. This is not me telling me how good I am or the Victorian government saying how good we are. We have the shortest planned surgery waiting times in the country – did you hear that? The shortest planned surgery waiting times in the country.

Members interjecting.

The ACTING SPEAKER (Wayne Farnham): Minister, through the Chair.

Steve DIMOPOULOS: We have the best cardiac arrest survival rates, but you will not hear that from the member for Lowan, because she is absolutely departing from truth. She is heading to fiction. She is misrepresenting the situation. She is alarming the Victorian community. We expect far better –

Danny O’Brien interjected.

Steve DIMOPOULOS: No, I did not say it was all going well, Leader of the Nationals.

The ACTING SPEAKER (Wayne Farnham): Minister for Environment, through the Chair. I am this way.

Steve DIMOPOULOS: Sorry, Acting Speaker.

We were the only state that saw improvements in emergency treatment times as a percentage of patients seen on time – all hospitals, all categories – from the 2021–22 financial year to 2022–23. We had among the quickest ambulance response times of any state. They have gone all quiet; they cannot cope. They cannot cope that the Victorian community never trusts the Liberal or National parties with health, ever – or education. They never trust those parties with health and education. They want everybody to fend for themselves. They do not depart too much from Adam Smith, really – a hundred years later and they still subscribe to the economic rationalist theory: if you can afford to pay your way, you should pay your way.

A member: Through the Chair, please.

Steve DIMOPOULOS: I think that was through the Chair.

Anyway, we have also grown the workforce by almost 50 per cent since 2014. The member for Lowan talked about the workforce. She did the whole appeal: ‘The workforce work really hard.’ Of course they work hard, but you know what, when you had a chance to support them, you did not. It is okay to pay lip-service to the workforce, but we actually put our money where our mouth is with the workforce. We have grown the workforce, adding an additional 40,365 nurses, midwives, doctors and allied health professionals over 10 years. They would not do that over 100 years; they would not know where to start. And then we have had the biggest year-on-year growth in the past 12 months in Victoria’s history. We made it free to study nursing and midwifery, with sign-on bonuses for graduates. We strengthened Victoria’s nation-leading patient ratios, something the other side of politics tried to dismantle.

I will get to the rest of the bill, but it is not appropriate to let those ridiculous mistruths stand in Hansard from somebody who is one of the biggest alarmists I have seen and also has a glass jaw. You come back at the member for Lowan and she falls apart. Anyway, the point about this is – of course –

Emma Kealy: On a point of order, Acting Speaker, the minister is misleading the house. I am more than happy to punch back when I am punched.

The ACTING SPEAKER (Wayne Farnham): There is no point of order, but I will ask the minister to come to the bill – a mention of paramedics would be good.

Steve DIMOPOULOS: Okay, Acting Speaker. This is a very, very important bill and I have enormous pride in speaking on the bill, because it is an Australian first – and I think the member for Lowan did actually accept that – effectively recognising highly specialised and trained paramedics to take some pressure off the emergency departments of hospitals but also, more than that, to actually give treatment more quickly to people that they are trying to help by arriving at their front door or wherever they may be in distress and needing an ambulance. They will do things like, for example, wound care and closure; treating minor infections, dislocations and fractures; and a whole range of other minor treatments of patients. It has worked well in the UK, Canada and the Netherlands, as the Minister for Health said in her second-reading speech, and they will have the powers to obtain, possess, use, supply, administer and prescribe scheduled medicines.

I was one of the lucky people to attend the launch of this announcement in my electorate, at Monash University in Clayton, where we saw some of the highly trained paramedics who would be amongst the first graduates. The first graduates, some 30, will be on the road in regional and rural Victoria by the end of 2026, and early next year the university will take the new admissions for the next batch.

So I thank Monash University for their collaboration with us. That institution is extraordinary. You cannot build a paramedic workforce and you cannot build a health workforce if you do not have the training providers, whether that be Monash or other training providers. You know, when the Monash heart hospital – another proud Labor government achievement and the only heart hospital in Australia, in the country – was being proposed and constructed the vice-chancellor, now Governor of Victoria, said to me it would be bigger than many heart hospitals around the world because of its collaboration with the medical faculty of Monash University, because Monash University’s medical faculty is one of the biggest medical faculties around the world. This is the capacity of the training opportunities available to us because of that prestigious university and because of the heart hospital.

Of course across the road we have got the Moderna plant, again a proud Labor government achievement. The then Premier, the current Premier and the Treasurer and others were involved in procuring that. And we have got the synchrotron, another proud Labor government achievement under John Brumby and Steve Bracks. This is one corner of Blackburn Road and Wellington Road in my electorate – one corner – let alone then the rest of the businesses and the med tech industry around that area. Then those on the other side, that unimaginative, hopeless lot on the other side, say, ‘You can’t have a Suburban Rail Loop.’ How do you get to those institutions and facilities? How do you get there? Monash University is the biggest university in Australia. Monash heart hospital is the only heart hospital in Australia. Monash Health is the biggest hospital network in Victoria. Do you leave them all without a train line? Do you leave customers, patients and students without a train line to those prestigious facilities?

For all those reasons, because we have built the ecosystem of the health services of this state – the workforce, the infrastructure and now the transport links to those very extraordinary facilities – this paramedics practitioner bill is just another notch in the belt of significant achievements and building on a workforce capacity in this state that will be unmatched.

Roma BRITNELL (South-West Coast) (12:42): I rise to speak on the Drugs, Poisons and Controlled Substances Amendment (Paramedic Practitioners) Bill 2024, which basically is a bill that amends the Drugs, Poisons and Controlled Substances Act 1981 to allow a legal framework to be put around ambulance officers who want to upskill and become practitioners, a concept that we saw in the nursing world many years ago and that has been quite a successful advantage to the system. So I absolutely think this is something we should be endorsing. I look forward to talking to the ambulance officers as they do upskill and to continuing my support for them, because I think they do an amazing job. Ambulance officers under extraordinary pressure do amazing work. They do not often have around them the system that I worked in, a hospital with everything coming out of the wall, like oxygen and suction; they have to pull it all out of the back of a vehicle and attend to people in extraordinary situations in farm accidents or road accidents. So I always take my hat off, and I loved the time that I did spend working with the ambulance when I was training.

But I think this bill does not go far enough. We have had 10 years of a Labor government who have destroyed the health system, and the ambulance officers need far more support than just these 30 trainees that we will see becoming practitioners. If the government were really serious about giving them the resources they need, they would probably start with the issue we have got in Portland and fix it. We have a helipad in Portland that has been closed for two years. No-one has given the community an understanding as to why that is. Initially the minister tried to blame the Civil Aviation people, and they said it was not them that changed any regulations. I have asked for a risk assessment so that we can see as a community what the risk assessment looked like that actually resulted in the cessation of the helipad being used. What we are seeing now is the ambulance officers having to go out to the airport and back and forth when the helicopter should be able to take off from the helipad at the hospital, as it had been doing previously for nearly 10 years. The people of Portland are not fools; they actually can see the yellow flashing lights and all the safety measures that are in place to make sure that the helicopter lands safely.

It disrespectful I think to take away a helipad with no explanation. If there are more safety measures that need to be put in place, then the government can get on and do that.

I have seen in other jurisdictions, in other states, where exactly the same situation exists. The government in Queensland, for example, is backing in the contractors that the government employs, but our contractors are not backed in by the Victorian Minister for Health and the Labor government, so they are not able to land and feel they can do so with the government’s backing. What needs to take place should be supported by the government even if there is some risk, because right now not landing a helicopter on the helipad at the hospital that was designed to have helicopters land on it is putting patients at risk. When they have been affected by trauma, which is often why you get a helicopter – major traumas – time is critical. It makes no sense, so the government needs to fix that. The community have waited long enough, and I call on the government to release that risk assessment and fix the issues that they see as a problem.

If the government was really serious about helping the ambulance service, they would do far more in Warrnambool. The ambulance officers in Warrnambool only have one mobile intensive care ambulance, and it is a sedan. The paramedics are dispatched in a sedan, which is not able to fit a patient, limiting their ability to respond to emergencies that require a highly skilled team. In a situation like a cardiac arrest, for example, a single MICA paramedic is currently dispatched and is expected to perform life-saving procedures like intubation, cannulation and defibrillation, all with just one pair of hands until backup hopefully arrives. This unrealistic expectation puts paramedics and patients at risk. All they are asking for is a two-up system, like we have in the police, where two paramedic officers are dispatched with an ambulance that supports them, fully equipped. We see this in smaller jurisdictions, we see it in Ararat and we see it in areas that are not as highly populated as Warrnambool, so there is absolutely no reason. However, the government has just released their plan for the next five years, and Warrnambool is not going to be getting that MICA paramedic that they need for two officers with their ambulance.

This also restricts the area from being able to train further MICA paramedics, because we have situations where locals wanting to train have to go away. One particular gentleman has a very sick child and his family cannot have him in Geelong or Melbourne where he needs to be to train because there is more than one MICA to be able to help supervise. They can train in other jurisdictions around the state where they have the two MICA paramedics, with less population. Unlike what the minister has shared with me in her rationale for him not being able to train locally, like others have, it is simply because we have not given Warrnambool the resources.

Furthermore, we had this 15 years ago, with a population less than it obviously is today with the growing population of this state. We still have only two ambulances equipped for Warrnambool. It needs a third ambulance. Fifteen years ago that was what they were using to meet the demand of the population. Now that it has grown, there is clearly a need, but no, in that report that the government has released they have no plans to give Warrnambool the resources.

It is all very well to give a pay rise, and I am very, very pleased that the ambulance officers have got that. They deserve that. But when you are a health professional, there is nothing more debilitating as a health worker than losing a patient due to insufficient resources. As a former nurse I empathise deeply with the local officers who desperately need this third ambulance to meet the growing need and desperately need a second MICA paramedic.

I urge our community to really get behind our ambulance team and feed into the government’s inquiry. There is a parliamentary inquiry on now; it is open until February. Write up your stories, I urge you, to help our ambulance officers. If you did not get the ambulance on time that your family needed, if you were experiencing, like I heard about in a cafe in Warrnambool, a situation where someone collapsed and it was an hour and the staff were having to step over this person who had collapsed for an hour because the ambulance could not arrive, please get that submission on the internet on the Parliament’s website and feed your stories in. It helps our ambulance officers. They need your support.

Here we have 10 years of Labor, and the health system that I used to once proudly say we were very blessed to have in Victoria is in an absolute crisis. After 10 years of starving the health services of much-needed funding, even today it is becoming more evident – it is in the news today – that in 2018 the cracks were showing. Our waitlists for emergency surgeries are absolutely too long – 61,000 people waiting for planned surgeries in pain, often starting to get concerned about how many opiates they are having to take to manage that pain. Very, very clearly we have seen, and I have certainly had cases in my office, even children addicted to opiates waiting for hip replacements, which is something you never, ever want to see.

I am really sad to hear my nurse friends tell me that they are being asked by the theatre team to actually take leave or go and work on the wards. We have got theatre lists that are not being filled because we have not had the full complement of anaesthetists, general surgeons, other surgeons and other specialists that are actually needed. I understand that 20 physicians have been employed recently by the hospital, but whilst we have got a Department of Health and a government, the Labor government, not doing the analysis of what is needed and utilising the resources or getting the resources that are needed, we should not have any theatres not at full capacity when we have got 61,000 people on a waitlist. It is devastating to the nurses that need to be supported to do the jobs they love and have such stress levels going on. The levels of sick leave and burnout that they are experiencing they are telling me about. It is really quite a crisis.

We were promised a hospital that would be built to scope. We waited years and years because we were told as a community that the right planning had to be done, and yet, after the Premier visited – but she did not say it because she was not game enough while she was there – a week later they said, ‘No extra funds for Warrnambool Base Hospital because costs of building have gone up, so cut the scope. We’re currently redesigning and having to cut out things like pathology and upgrades to parts of the hospital that were deemed necessary just a few years ago and are now not necessary.’ Surely if the government can find money for other hospitals that they have increased the funding to – and if you just have a look around the state where many of the Labor seats are, they have done exactly that – why won’t they give a hospital in Warrnambool the extra funds they need? The building costs have gone up because of their dirty Big Build, and the waste is just criminal. We need that addressed, and they need to absolutely fund the hospital properly and make sure there is the scope there to futureproof it.

Steve McGHIE (Melton) (12:52):I proudly rise today to contribute on the Drugs, Poisons and Controlled Substances Amendment (Paramedic Practitioners) Bill 2024. I find it a bit ironic that the member for South-West Coast talks about supporting paramedics when those opposite were at war with paramedics when I was the secretary of the union only a few years ago. So it is a bit ironic to suggest that they would be supporting paramedics.

Anyway, as I said, I was the secretary of the Victorian Ambulance Union for a number of years, and I started the discussions with the former Minister for Health the Honourable Jill Hennessy back in 2016 about paramedic practitioners and continued those discussions with subsequent health ministers Jenny Mikakos and Martin Foley and of course the current minister Mary-Anne Thomas, who has now brought this bill into the house. I am pleased to say we have finally got there and we are introducing the paramedic practitioners into the state of Victoria.

Of course this was an election commitment by the Andrews–Allan Labor government, and we are delivering on that commitment. Yes, there are currently 29 paramedics that are studying the Australian-first Master of Paramedic Practitioner degree at Monash University, and it is fantastic. It will expand their level of care and how they can treat people prehospital or out of hospital. The commitment from the government is, while there are 29 paramedics going through the training in this this course in level of care and practice, our commitment is to 100 scholarships over the next four years. It started with 30. I think there are only 29 that are currently on the course, and we wish them well with their quite extensive training, an extension of what they currently do as paramedics. Most of them are very experienced paramedics that are doing this particular training.

We know that different models of out-of-hospital care need to be provided. The way the ambulance service is responding now – we cannot keep doing it the same way as we have done it for decades. The increased volume of case load – I think recently they have had the highest numbers of cases in a three-month period, and a high percentage of those cases are probably unnecessary emergencies that come through the 000 system, but the ambulance service has to respond. As the population grows and the demand grows, it is not just about putting more paramedics on the road. There are 2000 more paramedics on the road as of today than when this government came into office. When I left the union we had just over 4000 paramedics in the state of Victoria; now there is about 6500. So the recruitment into the ambulance service has been enormous in the last few years.

The paramedic practitioner is a new role, and the whole idea of it is to try and reduce the number of people that need to go into a hospital. It is about treating people at home, and depending on the acuity of their condition, it is allowing these newly trained and extensively trained paramedics to administer scheduled medicines. They can also prescribe and supply medicines. This is about treating people where they actually are, rather than having to come through an ED to be treated – unnecessarily in an ED probably, because it is better for them to be at home. If it is a nursing home or an aged care facility, then these paramedic practitioners can treat them there, and it is much better for the patients and the patients’ families.

Paramedics regularly transfer patients with serious but not life-threatening conditions to hospitals. Again, some of the treatment that these paramedic practitioners give will mean that these patients may not need to be transferred to a hospital, that they can be dealt with at home and recover at home. It is advanced clinical training. They will be able to assess and diagnose patients, treat them in the field, treat them at home, treat them in a nursing home, as I said, and again, that would be good for that individual patient but also for the ambulance service and the health system.

Before I run out of time, because I can see the clock, I did mention that they had 29 paramedic practitioners doing the course, and I am going to read out all of those 29, because it is history in the making. These people are starting this new concept in Australia, and I am going to read out all of their names. These are the ones that are currently practising, and these will be the first ones on the road providing this level of care to patients out in the field: Craig Beamish, Kim Baker, Philip Bell, Jo Brooks, Ben Carty, Julia Cosgrove, Sarah Dalton, Nancy Di Grande, Sean Duggan, Brian Gansbuehler, Jonno Harper, Michael Heffernan, Jayda Hunter, Robert Kemp, Norieul Kinross, Tennille Lakey, Justin Lanser, Glenn Lazzaro, Jake Lurati, Mark Lyszczarz, Jacob McEwan, Dion Meade, Michael Moldoveanu, Laura Mowbray, Shannan O’Leary-Colliver, Heidi Opteynde, Georgia Ryan, Martin Starick, Jade Taylor, Amanda Taylor-Hall, Megan Vearing, Peter Wagstaff and Bianca Margaret Wilkie. I congratulate them and wish them well in their studies and in their practice when they hit the road in dealing with and looking after Victorian patients. I should also mention the trainers Alessia Restiglian and Natalie Fonda. As I said before, I wish them all well, and I think Brendan Shannon is also another trainer of these fantastic paramedics.

I want to give a shout-out to all the paramedics around the state – they do an amazing job. Keep up the great work. I know that you are voting right now on your new wage deal. I wish you well. As I said, I started the discussions on this back in 2016 with the Honourable Jill Hennessy. Here we are in 2024, and you will be on the road by 2026 delivering this great service to the Victorians that need it, that will keep people out of hospital. You can treat people at home, in their nursing homes, in their aged care facilities, for better outcomes for those individuals, better outcomes for the ambulance service, better outcomes for the state of Victoria and better outcomes for the health services.

This is a fantastic bill. I commend the minister for bringing this forward. I commend the Andrews–Allan Labor government, which committed to this election commitment for the paramedics. I commend the bill to the house.

Sitting suspended 1:00 pm until 2:02 pm.

Business interrupted under standing orders.

The SPEAKER (14:02): I acknowledge in the gallery today the Ambassador of Türkiye His Excellency Ufuk Gezer and the Consul General Doğan Işik.