Thursday, 6 March 2025

Bills

Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025

Second reading

Debate resumed.

Bronwyn HALFPENNY (Thomastown) (14:53): I am very pleased to be making a contribution in support of the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. I hope that this is a further demonstration of the Allan Labor government’s commitment to nurses, medical staff, hospital workers and all those connected to our Victorian health system, as well as of course to the best patient care that is possible.

This legislation builds on previous commitments and enactment of legislation around nurse-to-patient ratios. In fact as I recall, the whole need for such legislation and previous election commitments around this from the Labor government was all due to the Kennett Liberal government actually referring industrial law matters to the Commonwealth, which then meant that enterprise agreements were not able to contain things around workforce in the state of Victoria. And of course we also know the terrible state that the Kennett Liberal government left the Victorian health system in.

It has been a long and ongoing commitment by Labor governments to build, strengthen and support our health system. We know that there is always lots to be done. There is always more that can be done, but we are ensuring that the health system in Victoria is a really world-class one.

I look at the northern suburbs, and most of the health system really revolves around Northern Health, which is the Northern Hospital, but of course there are also upcoming community hospitals in places like Craigieburn and Mernda. There are also investments in the women’s health clinic, which is also at the Northern Hospital, and the mental health hospital that is now also being built. All of these are things that are being built and funded under first the Andrews Labor government and now the Allan Labor government, and really the place has been transformed. When I first became an MP most non-locals would have thought that the education and research building was the actual Northern Hospital building, not the hospital, because it was all just full of portables and all over the place, and it really was nothing compared to what it is today. I really want to give a shout-out to all of the staff – medical and other workers and allied health workers – who are at Northern Health and the Northern Hospital. I have got to know many of them because I have made many, many visits to the hospital and the other surrounding services because we really have made so many announcements in the last few years.

The Minister for Health today was also talking about the women’s health clinic that we have also provided funding for and the First Peoples’ Health and Wellbeing centre in order to provide women’s health care to Aboriginal women in the area. They do provide an incredibly great service. I have always heard really great feedback from patients and those that they care for.

Getting back to the bill, this bill is all about, as I said, continuing on from our commitments to nurses and midwives to ensure from the point of view both of patients as well as of nurses or midwives that there are proper ratios in order to have the best care for patients and of course the best circumstances for nurses and midwives in order to do their jobs. It builds on what we have previously done, but this legislation is around ratios in specific areas of patient care. For example, some of the further ratios that we are looking at that are contained in this bill are in intensive care units, so that the ratios in intensive care units will see a one-to-one ratio for nurses to occupied beds for both level 1 and level 2 hospitals, and therefore all occupied ICU beds will have their own dedicated nurse assigned to them at all times. Of course we know that this is the area of care, this critical care end, where we really want to make sure patients have absolutely the best care in order to get through the critical health problems that they have. Also – and I know that this will be something that residents of Thomastown and surrounding areas will be very happy to hear – there will be an increase in ratios in emergency departments, because of course they are so busy. In particular Northern Health is the busiest emergency department in the state, so there will be more staff there to support those people that come in through emergency. When there are often very time-critical issues and diagnoses that need to be made quickly there will be extra staff there to do that.

Also of course it is really great to have been to the hospital just recently, again to look at the first stage of the second redevelopment of the hospital, which will include increasing the emergency department by something like 40 per cent as well as providing a children’s emergency department, a special area for those affected by drugs and alcohol and also actually a drug and alcohol hub in order to provide extra support and services for those coming through the emergency department affected by drugs or alcohol.

It is also great that this legislation will see changes to the midwife-to-patient ratios in both the postnatal and antenatal wards. It will go from having one midwife or nurse per six babies or mothers to one to four. This again is a very significant and positive change that will see greater support for mothers during and shortly after their pregnancy. We all know how many questions mothers, especially first-time mothers, have. There will be extra time that nurses or midwives can spend with the mother in order to answer some of those questions and assist in the various requirements, whether it is around breastfeeding, handling the baby or just concerns about the health of the child, because there will be those extra staff there to support the mother and baby.

Also, there will be an in-charge nurse on all night shifts, specifically for high-dependency units and coronary care, so that there is the same level of care of patients whether it is during the day shift, the afternoon shift or the night shift. Things that affect people’s health are not just happening in the day, in the evening or at night; they are happening 24/7, at all times, and we need to have staff there to support and care for patients at those times.

Again, I would like to give a shout-out to all the nurses and staff at the Northern Hospital, who do such an incredibly good job. We are really proud of the work that is done. It is such an innovative hub. The virtual emergency department was created through the Northern Hospital and staff there in partnership with some of the universities, and also we have one of the women’s health clinics and also the public fertility clinic, so people are not required to pay exorbitant prices for fertility treatments. They can apply to go to the Northern Health fertility clinics and get those services there. We all know that the money that you have to pay for fertility treatment should not be the barrier between whether you have or do not have children.

The safe patient care legislation builds on previous legislation and previous commitments. This really has addressed many aspects of the hospital and healthcare system to ensure that there are the right number of nurses and midwives to ensure maximum care for patients. I know that the residents of Thomastown will be really happy to see this very important step in further helping them get the right care and the best care when they need it.

Kim O’KEEFFE (Shepparton) (15:03): I rise to make a contribution on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. The bill seeks to improve patient care and safety with legislated requirements for more nurses and midwives across the public hospital system. We do not oppose the bill and its intent to improve health outcomes for patients as well as provide more support for their amazing nurses and midwives. I want to acknowledge the incredible dedication of our health workers, and I am so grateful for all that they do for their patients and the hard work that they provide. They are appreciated, admired and truly valued.

We all want to see better patient and health outcomes for our hardworking, dedicated health workers, who turn up every single day to look after their patients. Over the years I have had close contact with many of my local nurses and health workers through my business and also when I have needed medical care. I also saw firsthand the dedicated midwifery staff when I had my first daughter, who was born premature. That is quite some time ago, but you never forget when you and your child are supported and provided with the medical care and support that you need.

During COVID it was an incredibly tough time for the hospitals and their staff. Everyone was trying to work through the pandemic and the impact on both staff and patients. I was mayor at the time, and it really was a time that I will always reflect on. We saw the incredible dedication of our healthcare workers at the most difficult of times and the historic challenges that they faced. We absolutely must ensure that the best of care and support are provided to our health workers and to our patients.

However, concerns remain about our health services’ ability to meet the new requirements given the current workforce shortage, the numbers of additional staff that will be required for compliance with the legislation and the budgetary constraints with this bill. The bill introduces staffing ratios into ICUs, establishes a one-to-one ratio for ICUs on all shifts in level 1 and level 2 ICUs, increases staffing ratios in resuscitation bays at level 1 hospitals with emergency departments, requires one nurse for each resuscitation cubicle on morning shifts at specific hospitals, increases staffing ratios in postnatal and antenatal wards, requires one-to-four midwifery ratios on night shifts in prescribed health services, introduces in-charge roles for night shifts in standalone high-dependency units and coronary care units and adds an in-charge nurse team leader and a liaison nurse to ratios at level 1 and level 2 ICUs.

The bill also seeks to provide an in-charge nurse, a team leader and a liaison nurse, who will be introduced in addition to the specified ratios on shifts in level 1 and level 2 ICUs to provide essential support to staff, patients and their families.

There are valid concerns about how hospitals will manage these changes. Given the challenges we are facing in our region with chronic staffing shortages and severe budgetary constraints, hospitals are already struggling. We already have a severe healthcare worker shortage at Goulburn Valley Health, and staff are already being pushed to the limits. We need real solutions that will address the current issues. What is proposed in this bill does not align with the current critical staff shortages, issues and budgetary restraints that hospitals are experiencing, particularly in my electorate. I met with Matt Sharp, CEO of GV Health, last week, and he said he did not have a lot of detail on how this would work. So the CEO does not have the details on how this will be managed. As noted in the bill, essentially it is up to the local provider to interpret the bill and how it will work within their hospital and overall organisational setting.

During the bill briefing we asked if modelling was done regarding the impact on the broader health workforce, especially given existing nurse shortages. The Department of Health representatives said it is left to the health services to review their operational capacity. This rings alarm bells, as we are very aware of the current challenges, as I mentioned, at GV Health. Basically our hospitals are told, ‘You go and work it out.’ The department was also asked in the briefing which hospitals had not been able to meet the existing ratios. This was taken on notice, and as yet we have not had a response. There is also a lack of deliberation and direction as to how it will impact a hospital’s budget and what the ramifications are if it does not meet the enshrined ratios. These are some of the sensible questions. It is not about not supporting the intent of the bill; it is the practical reality of meeting the criteria.

The government has allocated $101.3 million to implement and increase staffing levels; however, it has not been able to provide the detail of this allocation in the budget papers. It is unclear if the allocated funding will be sufficient to meet the higher costs of employing more casual agency nurses if hospitals are unable to recruit permanent staff. That is the exact issue that GV Health will face. Staffing within GV Health is a major issue, as I have mentioned. CEO Matt Sharp has been quite upfront about the staffing difficulties and challenges of his hospital. The current staff shortages at GV Health are around 450. Despite their best efforts GV Health had only 45 new nurses start between July and November of last year, and only one of these nurses was from Australia. The rest were nurses from overseas. There have been significant challenges in the health sector, and we all want to see improvement and support for our hardworking, dedicated health workers. Staff shortages are a critical issue, and patient care is being impacted.

GV Health has experienced ongoing ramping, and medical staff are speaking out. I was contacted by a very distressed emergency department nurse who raised serious concerns about the severe staff shortages, which force beds to close and some nurses to work additional 10-hour shifts after completing their initial afternoon shift. She said staff are overwhelmed and overtired. She said the conditions are unsustainable and have led to staff burnout, resignations and further strain on the health system.

Health services are also already under enormous financial strain. There are valid budgetary concerns within my electorate about the proposed increased ratios and the impact on staffing levels and costs. Goulburn Valley Health’s most recent annual report showed an operating deficit of more than $40 million for the 2023–24 financial year – in fact the worst in the state – and a hugely concerning negative seven days of cash at its disposal, so they do not have enough funds to meet their expenses. That figure – think about it, a $40 million deficit. How on earth will this hospital be able to add additional staff to meet the criteria outlined in this bill? This government obviously is so out of touch with what hospitals are actually facing. This government is asking for further hospital cuts. I found it astounding that my local hospital is in this position.

The Allan Labor government is neglecting hospitals, health workers and the health care of patients. As noted in GV Health’s report, GV Health’s operating result was impacted by the ongoing increasing costs of replacing vacant positions with contract staff and a reduction in operating revenue. We are seeing more and more reliance on temporary contract staff at GV Health, and it is struggling to secure more permanent staff. It is a significant extra cost to have temporary staff ongoing.

The negative seven-day cash balance held by GV Health really shows the crippled financial position they are in through trying to plug workforce shortages, pay bills on time and pay staff. Yet hospitals are being asked to reduce their expenses, affecting jobs and service delivery, and the amalgamations will only put more pressure on hospitals and their delivery, significantly impacting regional patients. It is difficult to see how the already struggling health sector will be able to meet these criteria to increase staff ratios and meet the additional costs. The bill suggests a staged implementation process, which suggests that it will enable health services to plan and prepare for these improvements. This is suggested in the 25 per cent of additional staffing being implemented from the day after royal assent, 75 per cent from 1 December 2025 and 100 per cent from July 2026. They have this suggested staged approach but no understanding of the current significant pressures hospitals are already facing to actually recruit those numbers. The bill does not factor in the vastly different circumstances and challenges of regional health care. Attracting healthcare workers is no easy task, particularly in regional Victoria. You also need to house the workers should they relocate and then hope that they do settle and stay in the region.

Last week I got to welcome some of the new medical students and interns at GV Health. I really enjoyed hearing about their backgrounds and their future aspirations. These medical students are just beginning their journeys, and they gave me so much hope for the future. Most have come from different origins and from a variety of cultures, and living in regional Victoria can be a very new experience for them. I got to give my spiel on the great life that you can have living in my electorate, hoping to retain such important medical staff, but the reality is many will move on once their required training is completed, so we desperately need to attract and keep healthcare workers in regional Victoria. We also need to have adequate facilities, and the lack of infrastructure investment is also impacting on our health sector. GV Health has only had 50 per cent of its redevelopment funded and completed. Stage 2 of the hospital needs to be completed, including radiotherapy. Having treatments close to home is critical for both the patient and their families.

Yesterday we had community from Albury–Wodonga hospital protesting on the steps of Parliament, literally begging for their hospital development. Their frustration was also experienced in the chamber. It is wrong when communities have to go to this level to have their voices heard. The government must prioritise health in regional communities. We cannot comprehend that city-centric projects with billion-dollar cost blowouts are being prioritised and pushed ahead above hospital upgrades and people’s health. This government have their priorities all wrong.

I wish to acknowledge again all of our dedicated health workers and the service they provide to the community, and we must continue, as I said, to support them in every way possible, but regional communities and regional hospitals desperately need more support with this significant staff shortage that we are experiencing, which is impacting on staff and patient care.

Luba GRIGOROVITCH (Kororoit) (15:12): Acting Speaker De Martino, it is wonderful to see you in the chair today during International Women’s Week, and I love the purple as well. It is my pleasure to make a contribution to the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. I do so because Labor knows that our health system is built on the skill, the dedication and the compassion of Victoria’s nurses and midwives, and we all salute them. We know that this was particularly true during the pandemic, where our nurses and midwives worked incredibly hard to keep Victorians safe while responding to unprecedented demands on our health system. I have got to say, on listening to the contributions from those opposite, I am really pleased to hear that they will not be opposing this bill today.

I am also very pleased to make mention of my good friends from the Woodlea Seniors Association, who join us here today. This group I have met with on a number of occasions, as I know the member for Melton also has. Both of us are very pleased that they were able to join us here today. On meeting with them in the electorate I have spoken to them about a range of issues from public transport and toilets in parks to roads, Leakes Road, gyms and of course – you can guess it – health, because health matters to everybody. As we all know, it is an important issue and one that we all need, because if we are not healthy then we are not alive. If we do not have nurses, it is a similar story. In 2022 at the election the Labor government committed to further protecting and strengthening ratios. We committed to this because it is what our nurses and our midwives told us that they wanted. With this bill, we are delivering on those commitments. Our healthcare workers know that only Labor have their backs, and we always will. Our health workforce knows that Labor listens and it implements ideas that are good for our communities.

We are proudly the party of nurse-to-patient ratios. Nurse-to-patient and midwife-to-patient ratios were first introduced in the year 2000 under former Premier Steve Bracks. That was a Labor government. But the former Liberal government under Ted Baillieu tried to force nurses to trade them away as part of their enterprise agreement negotiations. It is why in 2015 under a Labor government Victoria became the first state in Australia to enshrine the nurse- and midwife-to-patient ratios in law. Now the Allan Labor government is building on this by introducing stronger and safer nurse- and midwife-to-patient ratios, ensuring the very best care for Victorian patients and their families. The new ratios are the result of extensive consultation with nurses and midwives and of course their mighty union, the Australian Nursing and Midwifery Federation, and health services. These ratios will set in stone one-on-one nurse to occupied bed ratios in ICUs on all shifts for level 1 and level 2 hospitals, meaning that every occupied ICU bed has a dedicated nurse assigned to it at all times. ICUs will also require a team leader and liaison nurse for the very first time. There will be improved staffing ratios in resuscitation cubicles in emergency departments on morning shifts, bringing morning shifts in line with afternoon and night shifts; one-to-four midwife-to-patient ratios in postnatal and antenatal wards on night shifts, down from one to six; and an in-charge nurse on night shifts in standalone high-dependency units and coronary care units.

Only an Allan Labor government will continue to support and invest in our dedicated health workforce, because we know how important it is to deliver world-class care for all Victorians. Since we came to government in 2014 Labor has grown our healthcare workforce by nearly 50 per cent. That is an additional 40,000 nurses, midwives, doctors, allied health professionals and other hospital staff in the state’s health services – an additional 40,000. That is huge and something that this government should be commended on. Almost one in four of these new roles have been created in rural and regional Victoria. There are now 45 per cent more nurses and midwives and 78 per cent more doctors in our hospitals than when we first came to office. In fact last year saw the biggest yearly growth in Victoria’s history, with our workforce growing by 6.7 per cent in just one year.

Our on-road paramedic workforce has also increased by over 50 per cent, with 2200 more paramedics on our roads since we came to government. The Allan Labor government continues to invest in the people delivering critical life-saving health services to the Victorian community, supporting initiatives that help to train, attract and retain staff. This includes sign-on bonuses and supports to train and upskill our nurses and midwives, making it free to study nursing and midwifery, speech pathology grants and delivering Australia’s first paramedic practitioners. We have also delivered training and recruitment programs, including the $270 million Making It Free to Study Nursing and Midwifery initiative to build the supply, capacity and quality of our nurses and midwifery workforce.

The 2024–25 state budget invests a further $183 million in workforce initiatives. The new ratios build on the Labor government’s 28.4 per cent pay increase for our hardworking nurses and midwives, helping to retain and recruit more nurses so more Victorians can get the very best care. Through this historic deal we are also recognising and rectifying the historic undervaluing of this highly feminised workforce, an important step towards gender wage equality in Victoria. In addition to the wage increases, the new agreement backs our existing workforce and encourages a new generation of nurses and midwives by delivering preserved longstanding career structures and opportunity for progression; incentivised permanent work through a new change-of-ward allowance, which will compensate nurses and midwives when they are moved from their base ward; improved night shift penalties for permanent nurses and midwives; a ‘right to disconnect’ clause; improved access to flexible working arrangements, recognising that nurses are available 24/7; reducing the qualifying period for parental leave from six months to zero; and recognition of service for interstate public sector nurses and midwives who have relocated to Victoria.

Year on year this Labor government has continued to increase funding to our health services, because we know that that is what matters. The Allan Labor government is investing record funding into Victoria’s world-class public health system. This includes an uplift in the price that we pay all hospitals for the care that they deliver. We are investing an additional $1.5 billion on top of the more than $8.8 billion invested in this year’s budget, bringing our health funding up to more than $20 billion and more than 25 per cent of Victoria’s entire budget expenditure. This is on top of $15 billion in funded health infrastructure projects that are under construction and on the way, like the new Melton hospital and of course the Footscray Hospital. We always will support our hospitals, because that is what Labor does.

Contrast the Labor’s government record of achievement, listening to and working with our healthcare workers, with that of the Liberals and Nationals, and the difference simply could not be starker. We all remember the Liberal and National parties’ secret plan to cut hundreds of nurses and get rid of the nurse-to-patient ratios when they were last in government. We remember when they tried to undercut ratios to save $104 million when negotiating with our hardworking nurses and midwives. We also remember when the health minister David Davis and his department drew up the contingency plan to replace the thousands of nurses who were concerned that they would have to resign because they could not safely care for patients.

When last in government the Liberals and Nationals also went to war with our paramedics for two years, attacking our paramedics and running a smear campaign against them. Can you believe it – a smear campaign against paramedics. The Allan Labor government will not be accusing paramedics of staging photos at an emergency department or of writing fake letters. We will not be calling paramedics who are members of their union ‘hardline’ or ‘stooges’. That is not something we would ever do.

We remember when we first enshrined nurse-to-patient ratios into law and all of those opposite, including the then Leader of the Opposition, the member for Bulleen – all he cared about was the cost. We all remember during the 2022 election campaign how the member for Bulleen openly bragged about not consulting with healthcare workers or unions on policy, dismissively telling them to ‘get used to it’ if a Liberal government were in power. It is no wonder our healthcare workers refused to stand with the Liberals at the last election when they were treated with such contempt. We remember how you guys privatised hospitals in Traralgon and Mildura.

The ACTING SPEAKER (Daniela De Martino): Through the Chair.

Luba GRIGOROVITCH: We remember that. I want to thank our dedicated healthcare workers for the incredible work that they do in delivering world-class health care despite record demand. These are the ones who drive health care here in Victoria, and the Allan Labor government will always, always back them in. I am proud that this side of the house will always back them in. Nurses are salt of the earth individuals who we owe many thanks to, and it gives me great pleasure to commend this bill.

Cindy McLEISH (Eildon) (15:22): I too rise to make a contribution on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. And I just want to point out to the member previously on her feet that in my time in Parliament we have had three nurses as MPs, and we still do. I am so pleased that you have described them as the salt of the earth, because the shadow health minister Georgie Crozier in the other place is exactly that: an experienced nurse and midwife bringing so much experience and understanding of the health system to our side of politics. As I said, in my time in Parliament we have had three nurses standing shoulder to shoulder with us as Liberal Party members.

This is the third go that the government have had trying to get this right. It was in 2015 that the Andrews government introduced the first Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act, and that set minimum staffing for nurses and midwives in the Victorian public hospital system. There have been two goes since that; this is the third. We have had changes to the ratios in specific settings – stroke, haematology and oncology wards and palliative care, aged care, birthing suites and emergency departments – and this goes a little bit further. Here we go now with the latest lot, which is intensive care, high-dependency units, coronary care units and emergency departments.

The Liberals and Nationals are not opposing this bill. We do have some unanswered questions, though, from the bill briefing. I attended the bill briefing. I thank the minister for making that available – and the department – but it is disappointing when we do not get responses to the questions. We have particular questions that were raised at that bill briefing, and we have not had the courtesy of having a response. We had questions around modelling, and we noticed that the heart hospital has also been left off this. We had questions about why that was so and whether it was an oversight or if it was coming a bit later, and we have nothing about that.

I also want to highlight the incredible strain our hospitals have been working under in the last few years. We know that to put these ratios in place they are going to have to have more staff, and in the meantime there will be a lot of pressure on the workforce, because there are not enough people out there. There are not enough nurses out there at the moment – many of them are leaving – and the hospitals are really struggling with the financial strain. I think it was only in November last year that it was reported through the annual report – this is not me making stuff up; this is real stuff, through the annual report – that there were operating deficits across the board of about a billion dollars. It is extraordinary how the government expects the hospitals to get their way out of that. A number of other things were happening at that time, and the government was looking at amalgamations of hospitals as a way to try and get around that.

I want to talk about some of the deficits. Monash Health had a $321 million deficit; Northern Health, $115 million; Western Health, $102 million; Eastern Health, $100 million; Peninsula Health at Frankston, $59 million; and Albury Wodonga Health, $52 million. These are significant sums of money. To implement the safe patient care ratios the government are going to have to put more nurses on – fine; they are going to have to find them – but they are also going to have to fully fund the hospitals so that they can actually manage it. The workforce issue is significant, and I get very worried that the government underplay this completely.

Not only have they been operating in deficit, but there was an alarming increase across the board of about a 50 per cent increase in WorkCover premiums. The Alfred – this, again, is from the annual report – had a 60 per cent increase, and that meant they needed to find an additional $5 million just in WorkCover payments. The Austin needed to find $6.8 million. This is all through the annual reports. This is not stuff that I am making up; this is directly verifiable. All up there was something like $90 million in additional funding that the health workforce had to find just to pay the WorkCover bills, because the government could not manage their own finances and could not manage the WorkCover portfolio. They had to increase the premiums so that they did not have to keep subsidising them, like they had been doing – to I think about $1.3 billion, which the government had to fork out, of taxpayer funds – when they should not have been having to do that. For Northern Health it was almost $9 million in WorkCover payments that they needed to make; Peninsula Health, again in WorkCover premiums, an extra $2 million; Bass Coast Health, $784,000 – that was a 96 per cent increase in the WorkCover premium. For smaller hospitals like at Bass Coast it is extremely difficult for them to be able to find that sort of money. It goes on – and I could go on – because the hospitals are under enormous strain.

In country areas it is very difficult to find the additional workforce. We hear that all the time. We hear of the reliance on agency nursing to fill some of the gaps, and the cost of agency nursing is something that really blows the budget and leads to those deficits. I would really like the minister in the next budget to show where they are providing the additional funding so that hospitals can implement these ratios in the intensive care units, in the high-dependency or coronary care units and in emergency departments. I think it is important. They cannot do it alone.

We saw the government only last year looking at forced amalgamations of hospitals. We had enormous rallies, certainly in my electorate. We had 2000 people turn up one Saturday morning in Mansfield. Gosh, easily a quarter of the population turned up because they were worried about the future of their hospital. Now they are going to have to find – because they have maternity services and they have an emergency department – additional funding to make it work, and the government needs to make that funding available to them. We had a petition from Mansfield. I think it was signed by everyone in the town; it had over 8000 signatures. Yea and Alexandra had enormous petitions as well. We ended up tabling petitions with more than 15,000 signatures, which shows how important local health services and hospitals are.

We all value the staff at the hospitals. We value the nurses, the doctors and all the ancillary staff that make our health services good, but they need supporting, and when you see the conditions that they are operating on and the deficits that they are expected to try and somehow cover, it was really embarrassing for the minister to say to the hospital services, ‘You need to cut out your overseas trips.’ Well, I can tell you that in all of the hospitals in my electorate nobody ever has overseas trips or has an extensive marketing budget. It was embarrassing that that was even suggested for those health services.

The minister says amalgamations are off, but that is possibly happening by stealth with the networks and block funding that comes in. If block funding comes in, it is going to change a whole lot of the dynamics within the hospital system, and we may see hospitals close, which would be devastating because that is a loss of local jobs. That is a loss of jobs for the local nurses and midwives in those areas.

Nothing has been greater than yesterday when we had many people come from Albury–Wodonga on the train down to the steps of Parliament – that is a full day out for them – and there were doctors and nurses, people from the hospital very concerned about the future of their health care and what is going to happen in that area. They need a new hospital. They want it on a greenfield site. The minister is very determined not to meet the community need in that way, so I think that there is still a lot more that needs to be done here.

I said earlier that we are not on this side of the house opposing these nurse-to-patient and midwife ratios at all, but what needs to happen is we need to increase the workforce because people are leaving and people are going to agencies. We need to make sure there is that funding so that hospitals do not have to be running at a deficit, do not have to be amalgamated and do not have to rely on agencies, which makes it more and more difficult for them all of the time.

I certainly commend the services of our health workers in my electorate. I have Eastern Health hospitals and I have Mansfield, Yea and Alexandra, while Seymour is close by and Kilmore is not too bad, where women go for birthing, and of course we are on the fringe with the Northern, Austin and Mercy women’s at Heidelberg. They all do a terrific job but need to be supported so that the morale is strengthened, not weakened, and we do not have people walking away from those professions.

Jordan CRUGNALE (Bass) (15:32): I just want to start at the outset by saying that the announcement just recently of Bass Coast Health and Gippsland Southern Health Service having officially joined the health network in partnership with Kooweerup health, which is also in my electorate, and Peninsula Health and Alfred Health to form Bayside Health, a working title, is something we are really thrilled about. The strong links are there. It makes sense. It is logical. It is our natural pathway for health care and complex and specialised needs. It builds on and strengthens the existing MOUs already in place. Importantly also for our healthcare workers, it means more opportunities to develop their careers and gain experience working across the network.

It is important to emphasise, unlike what those were saying opposite, that this does not mean each service loses its identity, which I know is deeply treasured in my electorate. It is valued and embedded in our community. We have got a strong local history spanning a century with our health services, especially Kooweerup and also Bass Coast Health, and we see this time and time again with, for example, the collective outpouring of support via the many fundraisers organised by auxiliaries, local businesses and even the visual representations as you walk through the buildings themselves. So I just want to thank the respective boards and CEOs from across the five health services and also the community and health workers for being very active in advocating for this group. I will note that New South Wales has 15 local area health networks and WA has nine, and we have over 70, so we are very pleased that we have Bayside Health formalised now.

I rise today to make a contribution on the Allan Labor government’s commitment to introducing stronger and safer nurse-to-patient and midwife-to-patient ratios through the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. Anyone who has had a personal or family experience in a hospital or simply visited knows just how important nurses and midwives are. They are there for some of life happier moments and in some of life’s most difficult moments, as the member for Wendouree in her contribution was talking about, ‘from the womb to the tomb’, and we are grateful for the care, compassion and dedication that they provide.

This amendment to the legislation means better support for nurses and midwives and better care for Victorians. The bill, as we have heard, introduces more nurses and midwives on the shifts at all hours of the day across our busiest intensive care units, EDs and high-dependency and coronary care units as well as more midwives in maternity wards. Nurses and midwives are there for many of us in that time of need, and our government is here for them. This bill is good for nurses and midwives, as it prevents strain and improves retention of our hardworking health workforce through improvements to minimum nursing and midwifery staffing ratios. It also ensures safe and high-quality health care in a range of clinical settings by making sure the workforce is supported to provide the best possible care to patients.

Nurse-to-patient ratios, as we have also heard in the chamber, were first introduced in the year 2000, this century. However, there were many attempts by the former Liberal government to remove or reduce these ratios during their negotiations with nurses. It was not until 2015, under a Labor government, that Victoria became the first state in Australia to enshrine nurse and midwife ratios into law. In 2018 we introduced landmark legislation to strengthen these laws for nurse-to-patient and midwife-to-patient ratios, which in turn increased the number of nurses and midwives caring for Victorians in settings including palliative care, birthing suites and special care nurseries as well as during peak times in EDs. The number of nurses and midwives on a variety of shifts were rounded up, not down, ensuring Victorians had the best care. Victorians suffering from stroke, blood disease and cancer had more nurses to care for them with those ratios in acute stroke units, haematology wards and acute inpatient oncology.

Unsurprisingly, the former opposition leader did not consult with healthcare workers or the Australian Nursing and Midwifery Federation on policy during his campaign, and healthcare workers refused to stand with them at the last election. In contrast, this legislation shows that our government is listening to the workforce, the ANMF and health services. The Allan Labor government are building on this important legacy by introducing stronger and safer ratios that will ensure the very best care for Victorian patients. There will now be one-to-one nurse-to-patient ratios at ICUs at level 1 and level 2 hospitals. This means that every occupied ICU bed will have a dedicated nurse assigned to it at all times. We are also introducing the position of team leader and liaison nurse in these units for the first time and improving the ratios in resus cubicles in EDs on the morning shifts, and this brings the staffing levels in line with those on afternoon and night shifts. We are also improving the ratio in postnatal and antenatal wards on night shifts from one-to-six to one-to-four, and we are introducing an in-charge nurse on night shifts in standalone high-dependency units. These changes were made after extensive consultation with nurses, midwives, the Australian Nursing and Midwifery Federation and health services. We are taking a measured approach to rolling out these changes to ensure that health services are adequately supported and these new ratios are properly implemented. The rollout will be phased over several years, starting with 25 per cent of the additional staffing immediately after the bill becomes law, 75 per cent by December 2025 and full implementation by July 2026.

The Labor government has backed the implementation of improved nurse- and midwife-to-patient ratios through a $101.3 million investment to support health services with hiring or rostering additional nurses and midwives. We are making it free to study nursing and midwifery. This initiative will also support the implementation of amendments to the act and support attraction, retention, training and development to meet the additional workforce demand. This builds on our government’s 28.4 per cent pay increase for nurses and midwives announced just last year. Last year I also met with ANMF delegates Kate, Mim and Nicole from the Bass Coast in my electorate, who told me about the need for this increase and the positive impact it will have, and I thank them and delegates across the state for their continued advocacy. Locally, amendments to the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 will see an increase of nurse-to-patient and midwife-to-patient ratios at Casey Hospital, Dandenong Hospital, Frankston Hospital and Monash Children’s Hospital.

These hospitals service the health needs of my community in Bass and the south-east. Improvements to ratios will ensure nurses and midwives are supported to continue giving the best care to locals, and alongside this we are also investing in the healthcare system and infrastructure that ensures Victorians have world-class public health care into the future. I know the Casey Hospital expansion completed in 2020 has made a huge difference to the fast-growing south-east community. Stage 1 of Wonthaggi Hospital, completed last year or the year before, now has a new ED, three theatres, inpatient beds and a new surgical ward, and we are powering on with stage 2, with designs and planning underway, which will provide a new birthing complex, two new wards with up to 64 beds, a new outpatient clinic and always some more car parking as well.

We are also investing an additional $1.5 billion on top of more than $8.8 billion invested in this year’s budget, and this brings our health funding up to more than $20 billion, which is more than 25 per cent of Victoria’s entire budget expenditure. This is in addition to $15 billion in funded health infrastructure projects that are under construction or on the way.

In conclusion, in the time I have, I do just want to thank everyone who has contributed to the amendment of this legislation: the minister and her team and the department, the union, the health services and all the health workers in my electorate as well. This bill is just one part of our ongoing commitment to ensuring that all Victorians have access to safe, high-quality health care. The Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025 is an important step, as I have mentioned, in strengthening the care that we provide to our community, and by supporting our nurses and midwives, improving staffing ratios and continuing to invest in our healthcare system we are building a healthier future for all Victorians.

Jade BENHAM (Mildura) (15:42): I do seize every opportunity I get in this place to speak on behalf of my community about rural and regional health care, and I think it is important. Everyone in this place talks about how every Victorian should be able to access health care, and while the Nationals do not oppose the intent of this bill to improve safety and have better health outcomes – of course we would be in support of that – there are concerns, particularly around workforce retention in regional areas and the ability for our health services to actually meet the requirements of these new ratios, particularly given the challenges that we already have in our healthcare workforce at the moment.

Before I start, though, I must recognise the midwife that I had in Mildura. Sally Barker is her name. I am sure she will not mind me recognising her. She is still working. She still comments on my socials every time the kids have a birthday. She was brilliant with the prenatal care, the postnatal care. And I recognise Vicki Broad as well, who is the midwife – and in fact she has been named Midwife of the Year – from Robinvale District Health Services, which is the multipurpose service that I will protect until my dying day to make sure that it remains an independent multipurpose service, because the service that midwives like Vicki and Sally provide for the people of that community is exceptional. To win Midwife of the Year a couple of years ago was an exceptional achievement.

I have several hospitals and several healthcare services throughout my electorate, and I just want to illustrate where the challenges come from to retain workforce, to attract workforce, to support not only the nurses and midwives in isolated areas but also the people that they care for. Geographical isolation is a real issue and the prospects for professional development.

In Mildura we are very, very fortunate to have La Trobe University and their nursing program. The Dr Deb Neal Wing opened late last year, which is a state-of-the-art wing to train more nurses, which is absolutely phenomenal. The trouble is we have a housing crisis and accommodation issues. To attract people there to take up a course so they can train on the ground, what we actually really need and what would be a solution, which we have been working on for a little while, is end-to-end training for GPs and nurses using Monash School of Rural Health as well. We are very fortunate to have them based in Mildura. They also do an exceptional job.

However, that is Mildura, which is at the very top of my electorate. My electorate spans over 37,500 square kilometres, which is about 16 per cent of the state, and in that I have five different healthcare services with nine different campuses around there. The most remote is Murrayville. If you can imagine, Mildura is up right on the New South Wales–South Australian border. Murrayville is not a direct line either; you have to go out and around, because there are national parks to get around. It is 2 hours south of Mildura and 2 hours from the Murray River, so it is remote. It is the most remote town in Victoria. The closest town is actually Pinnaroo in South Australia. Murrayville has a bush nursing hospital. This bush nursing hospital, utilising Mallee Track Health and Community Service, are able to provide a really comprehensive range of essential medical and allied healthcare services. They do acute, they do urgent care, they do community and district nursing, they do residential aged care and they do allied health. They will have visiting midwives. They do an incredible amount at this bush nursing hospital in Murrayville, which was established by a volunteer panel in the 1980s.

It has not had an upgrade since. They are in desperate need now of a new roof. When you have a facility that is literally falling down and leaky, it is really hard to attract healthcare professionals, much less retain them. It is only $200,000 to replace that roof. We are not talking millions or billions; we are talking about $200,000 to fix the roof of the only healthcare facility in the most remote part of this state. You know what, they are Victorians too. Don’t they also deserve the very best of health care? I think they do. The community there certainly think they do. This is a farming community, and as all Mallee families know, you learn to do things for yourself otherwise you do not get anything done. They need some help now. They only need $200,000 to fix a roof. It is a pittance, really. When we are talking about budget blowouts, this infuriates me. We hear about budget blowouts on major projects, and we have got a bush nursing hospital providing health care for communities growing food for the rest of the world – $200,000, and they cannot get that. Maybe upgrading that facility would attract more nurses, more midwives and more allied health staff to service this community in the most remote part of this state. They are Victorians too, and they matter just as much as someone that is 100 metres from the Epworth hospital in Richmond, don’t they?

We have quite a few issues. I mean, it is a complicated beast. When you have such a vast expanse of the state where people live right throughout and you do not have all the required health services, travel is also an issue. We do not have a train. We have a plane, but flights are expensive and you have still got to get to Mildura to get there. A lot of people may travel to Adelaide, but of course the public transport now to get to Adelaide is very, very difficult. Getting to Melbourne is difficult, and it is expensive. In a cost-of-living crisis more and more people are using the Victorian patient transport assistance scheme.

The trouble is, the reimbursements from that scheme, VPTAS, are now taking up to seven months to come through, leaving individuals and organisations that utilise that service, like Sunraysia Information & Referral Service and Sunraysia Cancer Resources – I got a letter from SIRS last week saying that they are still owed over $218,000 from claims that were put in from October last year. That is insane. So if they are referred another patient who is a category 1 patient, for example, who needs urgent care in Melbourne, with no operating capital in the bank, how do they buy flights and get that patient the care that they need because they cannot get it locally? They cannot. It is putting lives at risk. As the member for Euroa said earlier today, it is now a life-and-death situation in regional, rural and remote Victoria and it is costing lives.

[NAME AWAITING VERIFICATION]

Here is another example. Darren is 59. He did the at-home bowel scan in September last year, which we are all encouraged to do. Be aware of your conditions and do the bowel scans; it is treatable if it is found early. He returned a positive test in October. He was told it would be three months for an appointment. He was still waiting in February – not for a colonoscopy, just for a consult – because of the public surgery waitlists. He is a category 1 patient with a positive result. I would not be able to sleep at night if that was me, not knowing if I had bowel cancer or not.

I am just befuddled when I hear members opposite say that every Victorian has access to equal healthcare regardless of where they live. That is absolute rot. There are people out in regional, rural and remote Victoria that cannot get an appointment, cannot get a bed and cannot get treated. But we thank our nurses, our doctors and our allied health staff, who are working but are so frustrated with the system that it is hard to retain them in regional Victoria. We do not oppose this bill, but we do oppose being neglected by this government and the health system in this state.

Pauline RICHARDS (Cranbourne) (15:52): I am so very pleased to have the opportunity to speak on this extraordinarily important Labor legislation. I do say it is Labor legislation because it is actually a piece of legislation that is typical of this government and the Labor governments that have been making sure that we support our workforce. Not by clapping, as Boris Johnson used to do – I think it was Boris Johnson that used to clap the healthcare workers as some sort of acknowledgement of how hard they were working during the pandemic, who then forgot to back up that clapping and that acclamation by making sure that their healthcare services were well funded and that their nurses and midwives were treated properly.

I am very pleased to have the opportunity to speak on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. I do take the opportunity to thank the Minister for Health for the hard work that brought this legislation here. I am going to take a little bit of a journey back in time as well to acknowledge not just the Minister for Health now but previous ministers for Health who made sure that this legislation was brought here and then built on and strengthened. This was always done as an act of collaboration with our nursing workforce, because we do not just clap our nurses, we make sure that our nurses are supported with extraordinarily important reforms like nurse-to-patient and midwife-to-patient ratios.

This legislation introduces staffing ratios for intensive care units through the introduction of a one-to-one ratio for ICUs on all shifts in ICUs in level 1 and level 2 hospitals, improves staffing ratios in resuscitation cubicles at emergency departments on morning shifts by prescribing one nurse for each resuscitation cubicle in hospitals that are specified in the schedule of the act, improves ratios in post-natal and antenatal wards by enshrining a one-to-four midwifery ratio on night shift in prescribed health services and introduces an in-charge nurse, a team leader, a resource nurse and a nurse liaison in addition to the prescribed ratios for shifts in level 1 and level 2 ICUs. This will improve ratios in high-dependency units and coronary care units and introduce an additional nurse in charge on night shifts in standalone HDUs and CCUs. It is really important to get these facts into Hansard to acknowledge what is actually done when we do legislation that acknowledges the work of our nurses and does not just acknowledge them but puts our workforce at the centre of our legislation.

I am going to take the opportunity to thank some of the nurses in my life. I am going to start closest to home with my brother; my sister; my sister-in-law; my beloved mother-in-law, who has passed away; my gorgeous niece; my aunty, who is well into her 90s now; and my cousin Jenny, who have all been extraordinary in supporting our community and working professionally – because this is a professional outfit – as nurses in some really high-powered and extraordinary workforce situations. And I am going to take some time to talk about the nurses from the community that I serve, nurses in the community of Cranbourne.

But just for a moment we are going to take a journey back in time. I am not just referring to Uncle Baillieu, who I think put the finger up at nurses, and the member for Frankston spoke about some of the behaviour of those opposite in previous parliaments. We were doing a little bit of research, the member for Frankston and I, and reflecting back on a missive that was sent by Lisa Fitzpatrick, who is the secretary of the Australian Nursing & Midwifery Federation (ANMF) and a great stalwart of one of the largest unions in Victoria and certainly one of the strongest unions in Victoria. On 2 October 2018 Ms Fitzpatrick wrote:

The unwillingness of 20 Victorian Liberal and some independent upper house members to work past midnight on a September evening meant the Safe Patient Care Amendment Bill was not passed.

Ms Fitzpatrick went on to say:

The legislative process will have to start again when the 59th Victorian Parliament commences.

And of course that did happen.

The Andrews Government’s Safe Patient Care Act Amendment Bill passed the lower house on 6 September …

But it needed to pass the upper house, and timing was tight. Of course Mr Davis was the key to the activities back in 2018.

It goes on:

Opposition MPs –

Brad Rowswell: Acting Speaker, I draw your attention to the state of the house.

Quorum formed.

Pauline RICHARDS: Back to 2018 and Ms Fitzpatrick’s update to the members of the ANMF, which continues:

Opposition MPs’ drawn-out speeches in excess of 200 minutes about champion Melbourne Cup winners, country race meets, and bookies’ ability to buy expensive European cars took precedence over debating a Bill to employ an additional 611 nurses and midwives …

So here we are. This is a really important piece of legislation, and I am so pleased that those opposite are not opposing this bill. Perhaps there has been an evolution in thinking; perhaps they have had a road to Damascus conversion, and I was pleased to hear in the contributions earlier that those opposite are not opposing this bill. But I did hear some rather unusual reflections on ratios and the importance of them from the member for South-West Coast.

I am going to take a moment to thank – and despite the quorum call I have got enough time – the nurses and midwives of Cranbourne and in particular many of the nurses and midwives who have fought for a long time to make sure that the legislation we bring in here today recognises and acknowledges our workforce as being at the centre of everything we do and recognises and acknowledges that midwives and nurses and making sure that our hospitals are staffed properly are at the centre of the way we fund our hospitals. I do take the opportunity to thank Hannah Spanswick, recognising that Hannah is here today and has been one of the early fighters for absolutely making sure that nurses and midwives are not just rewarded as they ought to be but acknowledged for the work that they do in making sure that this type of legislation, after many, many years of fighting, is brought here and strengthened. I also acknowledge Liz Barton, one of the very early fighters for nurse-to-patient ratios. She is somebody who worked very hard at Frankston Hospital, including in palliative care. I also want to acknowledge Thelma Stratov. Thelma is an amazing constituent of mine who was a member of the ANMF and has been fighting so hard for the type of resourcing and the type of acknowledgement that nurses and midwives deserve.

This legislation was formed because of the early battles of our union movement. It was not something that was given as an act of benevolence by Mr Davis in the other place. In fact when Mr Davis had the opportunity he sought to unwind all of the hard work that the ANMF did over many, many years. I particularly acknowledge my diaspora communities and the many nurses from Zimbabwe, from India and particularly from Kerala state and from the Philippines, who are the people that I serve as well, for the work that they do. Now with our new diaspora, the Dari speakers and the Hazara speakers, who work as a professional workforce, and especially the nurses at Frankston Hospital, those that will be staffing the Cranbourne community hospital and our Monash Health staff – they are topnotch professional nurses. This legislation is a credit to that workforce. It is a credit to the union.

Martin CAMERON (Morwell) (16:02): I rise to make a contribution to the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. As has been alluded to throughout our contributions on this side and has been noted on the other side, we do not oppose the bill here that we are talking about or anything that we can do to make sure that our hospitals and our health care system are running properly and have the right ratios of nursing staff to the incredible amount of patients that actually move through our hospital system. I give a big shout-out to our nurses, because they are the ones that are at the coalface of when people are at their most vulnerable. When you are going to hospital, whether you are going through childbirth or whether you are middle-aged or whether you are in your later stages of life, it can be a stressful time. Our nurses and doctors get to see the very best and also the very worst of people that are having issues.

The bill seeks to improve patient care and safety with legislated requirements for more nurses and midwives across the hospital system. In level 1 and level 2 ICUs a one-to-one nurse–patient ratio will be required for occupied ICU beds on all shifts, making sure that we have got the correct ratios there in our critical care units. We have also alluded to having better patient ratios with our newborns, so that is great.

One of the issues that we have not with the bill here but in regional Victoria and especially down in the Latrobe Valley – we are very lucky that we have a state-of-the-art new hospital, which is absolutely fantastic – is the trouble that we have, and I think everywhere has, with making sure that we can staff things adequately.

For the government to make sure that we can have these ratios and actually be able to staff all levels of our hospitals moving forward is a great thing. One of the issues that we have down there is attracting doctors and nursing staff to the area. We have our locals that move through our hospitals, but we are very, very reliant on doctors and nurses from Melbourne, interstate and also at the moment from overseas. The main issue that we have in being able to attract them is being able to house them in the community – as we know, we have housing crisis, so we need to free up housing there. But then also they bring their families with them, so we need to make sure that we have got adequate access to schools, kinders and day care centres. It is a huge area in the health space, and I think that anywhere you look around regional Victoria they would all be on the same page about this being the main issue.

As I said, the facility down in the Latrobe Valley is state of the art, but the hospital is not running at its full capacity at the moment because of the issue of attracting doctors and nurses, but also proper physicians coming in. Attracting anaesthetists has been a huge issue, but the hospital is starting to sort that out. It just makes our waitlists a little longer. We would love the hospital to be running at its full capacity so it would not be so underutilised as we move through. As I said, we all need the security of a great health service from when we are young to when we are older. You do have, and you see it all the time, people taking liberties. As a former plumber, one of the things I used to see with our elderly fraternity was them trying to climb up ladders to clear gutters and stand on the roof. They would fall off and break hips, arms and legs, and they would be required to spend a lot of time in our hospital system. If it was not for our wonderful nurses doing what they do best and looking after everybody that goes through there, we would be in a much worse position. So we thank them all the time.

One of the other places that works in conjunction with our Latrobe Regional Health hospital down there in Gippsland is the Latrobe Urgent Care Clinic service. This is a wonderful service that we do have. It is situated in Moe, and what that service does is actually relieve the pressure on the actual hospitals and the emergency services. I was lucky enough last week to actually go out there and visit the CEO –

Members interjecting.

The ACTING SPEAKER (Nathan Lambert): Order! There is a little bit too much chatter in the chamber. Perhaps if the members for Sandringham and Bentleigh want to have a long chat, they can do so outside the chamber.

Martin CAMERON: As I was saying, I went out to visit the Latrobe Urgent Care Clinic. I met with the hierarchy out there, the doctors and the nurses, and listened to them talk about the amount of work that they are taking on, and they are getting busier and busier all the time. They have a dental part to the urgent care clinic, and that is at capacity too. They are running some great stuff out of there. In talking with them, walking through the facility and seeing what they do and how important this particular clinic is to the make-up of the Latrobe Valley and what relief they do give to the hospital, they were telling me that when they actually get their allocation of money to run the services and attract the doctors and the staff, it is only for a 12-month contract. That causes issues for them to be able to attract these doctors and medical staff to come down and help. I hope at some stage with the urgent care clinics they can actually have a discussion about expanding that 12-month period to two, three or four years so they have got some certainty when they go out and target doctors and nurses. That is a big issue at the moment, because we are so light on with these practitioners in regional Victoria. Other hospitals sometimes jump in and cherrypick the best staff. That goes on everywhere; it does not matter whether it is in health or in business in general.

It was great to get out there and visit the urgent care clinic in Moe. As I said, the staff there work long, hard hours. They do see a lot of different people that come through their doors. They were telling me that football season is very much going to be upon us, and their weekends seem to jump up with people coming in with dislocations and fingers looking the wrong way. We need to make sure that they are well and truly funded. On the flipside, in our hospitals our emergency departments will also have a big uptick with sporting people that come in with breaks and need X-rays and need to have stitches and so forth.

As I said, we do not oppose in any way this bill going through today. We would just like to see with the nurse–patient ratios that they are fully funded and that they are right across Victoria and the people in the regions with their health care are getting adequate access to doctors and nurses and they are not just reliant on a Melbourne-centric situation – even right into far East Gippsland with other hospitals out there. The further doctors and nurses have to travel, the harder it is to attract them to stay. They will come and visit for a day, but we would like to keep them in the region full time. Kudos to all our wonderful medical staff. This is a good bill making our ratios better, and as I said, we are not opposing this bill today.

Martha HAYLETT (Ripon) (16:12): I rise today to speak on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. This is a bill that is very close to my heart. It is all about creating the best healthcare system possible in our great state of Victoria. It will set in stone one-to-one nurse to occupied bed ratios in intensive care units on all shifts for all levels 1 and 2 hospitals. It will mean that every occupied ICU bed has a dedicated nurse always assigned to it. It will also improve staffing ratios in resuscitation cubicles in emergency departments on morning shifts, bringing morning shifts into line with afternoon and night shifts. It will establish one-to-four midwife-to-patient ratios in postnatal and antenatal wards on night shifts, down from one to six. It will also introduce an in-charge nurse on night shifts in standalone high-dependency units and coronary care units.

These are the types of laws that only Labor governments introduce. We improved ratios after the 2018 state election, and now we are protecting and strengthening them even more. The bill will benefit not only the lives of nurses and midwives but also the lives of so many Victorian patients. It is laws like this that made me want to run for politics, as I am someone who had benefited from our public healthcare system as a little girl and who would not be here without it. I saw our nurse-to-patient ratios in action six months ago when I was admitted to hospital with skyrocketing blood pressure before my son was born. The nurses and midwives were real-life superheroes, caring for me with such kindness and expertise and putting my family at ease when they feared the worst. Their skill, dedication and passion blew me away, and it was comforting to know that they could focus on a smaller number of patients rather than having to juggle so much more. This is exactly what nurses and midwives have told us that they wanted. We listened, and we are now acting so that they can be even more supported in our healthcare system.

We know that those opposite do not believe in nurse-to-patient ratios. They tried to claw them back after the first ratios were introduced by the Bracks Labor government in 2000. They treated nurses terribly, and they tried to force them to trade their ratios away as part of their enterprise agreement negotiations.

Many nurses across the Ripon electorate remind me of this regularly. It was outrageous, and it is exactly why we enshrined nurse- and midwife-to-patient ratios into law back in 2015. Now we are building on this to ensure the very best care for Victorian patients and their families. These changes are backed by $101.3 million in the 2023–24 budget and build on our government’s 28.4 per cent pay rise for our hardworking nurses and midwives. It will not only help retain current nurses and midwives but also encourage a new generation of them to take up a career in health care.

Since we came to government we have grown our healthcare workforce by nearly 50 per cent, which is truly incredible. That is as an additional 40,000 nurses, midwives, doctors, allied health professionals and other hospital staff in the state’s health services. Almost one in four of these roles has been created in rural and regional Victoria, including our amazing health services across Ripon.

I want to give a particular shout-out to the hardworking staff at East Grampians Health Service in Ararat, East Wimmera Health Service in St Arnaud, Central Highlands Rural Health in Creswick and Clunes, Grampians Health in Ballarat, Inglewood and Districts Health Service, Maryborough District Health Service, Beaufort and Skipton Health Service and the Elmhurst Bush Nursing Centre. They do incredible work to deliver world-class health care in our rural and regional communities despite growing demand. They have benefited from our Labor government, with more funding, upgrades and support than ever before, and now we are protecting and strengthening their patient ratios.

We have also made nursing and midwifery degrees free to grow the workforce of the future, with so many of my constituents taking up this opportunity, and this is in stark contrast to those opposite. We all remember when they were in power and they went to war with our nurses, our midwives and our paramedics and when the former health minister in the other place David Davis had his department draw up contingency plans to replace thousands of nurses who were concerned that they would have to resign because they could not safely care for patients. They called our paramedics ‘stooges’ and tried to undercut nurse-to-patient ratios. They continue to treat healthcare workers with contempt, and that is why Victorians continue to not vote for them.

While we are redeveloping hospitals and urgent care units in Maryborough, Ararat, Ballarat and Inglewood, they are thinking about how they can cut, close and privatise our healthcare system into the future. Labor will always back our nurses and midwives, and that is exactly what this bill does. It is the least we can do for those who save lives every single day, including mine and my son’s. I commend the bill to the house.

Paul MERCURIO (Hastings) (16:17): I rise to give my contribution on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. I have been listening to the debates today, and I was a little bit disappointed that the debates on that side were very much not on the bill, but really an opportunity to sort of whinge and complain about maybe not having a hospital or not having some money for funding. It was just disappointing, because we actually all agree that this bill is a terrific bill and agree that we are going to support it. I guess the politics of it is that you take the opportunity to have a go at the opposition. I am a little bit tired of the glass being empty on that side and the glass being full on this side. Anyway, that is just a personal observation of mine.

I was thinking about this bill, and I have got notes which I might get to. If someone jumped on Hansard and had a look at this bill debate, read it or even listened to it, I am wondering what they would think of it. There has been a lot said on this side about the mechanics of the bill and what it does and the nurse-to-patient ratios, but I thought, ‘What does this bill actually do for someone like me or someone that has just looked at Hansard?’ It is pretty interesting, because on Monday I took my favourite middle daughter to hospital yet again. She is going in for pain treatment for the severe pain that she experiences because of her Ehlers-Danlos syndrome, her endometriosis, her adenomyosis and her postural orthostatic tachycardia syndrome. It is never easy taking your child into hospital, and I say I had to – I did have to; I did not want to. It is never easy standing up after you have sat with them waiting for them to go in and then walking away from the hospital.

It does not matter that my favourite middle daughter is now 33, I think – 34 this year. It never gets easy. But the one thing that helps is the nurse that comes out and talks to her. The one thing that helps is that peace of mind that she is going to be cared for by someone that legitimately, genuinely cares – by someone who loves their job, even though it is incredibly gruelling and hard and they have sacrificed so much over the last six or seven years in a very extraordinary time. It gives me some peace of mind that I can go home without being a mess in the car and I can sit at home wondering how my daughter is going, knowing that 24 hours a day there is a nurse coming in to look after her, to talk to her, to make sure she is doing okay. And when she is not doing okay, they are there to help her get through that.

That is what this bill does. It is not an opportunity to complain about not getting a hospital or not getting funding. This bill is not just about supporting the patient’s health and wellbeing and care but also about supporting me and everyone else here that has had to take their kid to hospital, or their parent or brother. That is what this this bill is. It also is about caring for the nurses and the midwives and making sure that they are getting the support that they need for their physical wellbeing and for their mental wellbeing. As I sat around going, ‘What is this bill?’ – I am going to talk about the boring bits and whatever. Actually I have spent that much time; I might not. But that is what the bill is.

It is something that I am trying to work on in this place, really understanding what the bills do for people out of this place, so that they understand the work we are doing but, better still, they understand the work that the nurses, the midwives and the rest are doing in regard to this bill. I think it is really important that we try and maintain that understanding that we are here to represent our community, and they do not necessarily want to hear us bickering about a bunch of stuff that we do. They do not necessarily understand things like the one-to-one nurse-to-occupied bed ratio, the changes in shifts and the one-to-six or one-to-four at antenatal and postnatal wards. They do not get that. I think it is important that we try and explain it in a different manner.

I am not going to go and do that. Instead what I also want to talk about is the idea that I spoke about in my inaugural. We often talk, and we talked in the royal commission a lot, about lived experience. People with lived experience especially in the health industry are so much better at giving what patients need.

I will just talk about one story quickly. When my wife and I had our first child – although my wife had it; I was just with her – it took 36 hours. The first labour was 36 hours. My favourite second daughter was born in 4 hours, but my favourite eldest daughter took 36 hours. She was hanging on. But in the time that we were there we went through three shifts of midwives and then they came back again. As two young, inexperienced, vulnerable people, which we all are when we take our kids to hospital or go into a birthing suite for the very first time, we were frightened. You are trying to have the courage and be brave, and you really rely on those people that stand opposite you that come into the room and go, ‘Are you okay?’ You go, ‘Yes, I’m okay’. ‘I’ll be back in a minute’. ‘Okay.’ And they come back in a minute and you know you are safe. The 36 hours of our first daughter’s birth was very long and very frightening, and we only survived it to a great extent because of the wonderful midwives. I believe one of them was pregnant. They were all terrific, but she was really terrific because she was pregnant so again there was that lived experience of knowing what is going to happen and whatnot. Anyway, my daughter was born. She is very loud and very opinionated. I love her very much, and she is terrific.

Not long after that, I heard that the midwife that had been wonderful and was pregnant had her birth at the birthing centre where we were, but she lost her baby.

A member: Oh, no.

Paul MERCURIO: Yes, really hard. She gave so much to us and to so many people, but I understand that after that she went back to work. I just think that when we talk about people with lived experience and when we talk about our nurses and midwives and all those people, we must remember the courage that they have to turn up to work every day in the face of all sorts of issues and difficulties, and having to watch other people maybe lose their children or loved ones. They turn up day in and day out with their lived experience and still remain compassionate and have empathy and courage. I just think it is really extraordinary. I would like to think that this bill acknowledges that also, because, again, the more we can do to help and support our frontline people, the better. I am very, very happy as part of the Labor government that in the EBA for nurses and midwives they got a 28 per cent pay rise. I do not think anyone that has actually been in hospital would begrudge them that.

The last time I went to hospital I had been to my doctor because I was a bit hot and I was not feeling too good. They decided to put me in an ambulance with lights and sirens, which was quite fun. I got to emergency and I was in a bit of a queue. I think my temperature was 42 or 43 – I was sweating. I am very grateful that they allowed me to jump the queue. I was in a little room waiting for treatment, and my doctor was very busy and could not help me, because in the cubicle across the way they were resuscitating someone, who died. I was lying there listening to it, and really it is quite horrific in that way. They were saying, ‘Do you want to go again?’ ‘No, we’ll leave it.’ Then my doctor came in with a smile on his face and the nurse came in, and I was thinking, ‘How on earth can you just go through what you went through and still come in and give me the time of day and be genuine and compassionate with me?’ They are extraordinary people, and I thank them from the very, very bottom of my heart. I commend this bill to the house.

John MULLAHY (Glen Waverley) (16:27): That is a hard act to follow. I must firstly acknowledge the member for Hastings and his wonderful, empathetic and caring contributions that he always gives in this chamber. He has certainly reminded me with regards to the new parent concerns that you have when you first turn up to the hospital. It was 6½ years ago now with my partner Donna and Orla on the way, and I remember that worry and concern that you have when you go in there. As soon as you go in there you are surrounded by professionals who on a day-to-day basis know how to look after you and know how to make sure that you feel confident that you are going to be looked after and that you are going to be okay. As hour after hour after hour goes by – we got up to 25 hours – though you are still concerned and still worried about what is going to happen, you just have that confidence that our nurses, our midwives and our doctors are there to ensure that you get the best outcome. I would like to start by thanking the nurses and midwives that looked after us through some concerning times. We got there: we got our little bundle of joy at 11:38 pm after 26 hours of that ordeal. I thank them for what I have today.

It is a pleasure to rise in favour of the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. From the outset I would like to thank the Minister for Health and her team for their efforts in bringing this important legislation to the house. I trust these changes will have a positive impact for all Victorians. Back in 2015, just one year into the Andrews Labor government, a significant piece of legislation was introduced, one which would transform our healthcare system. It was nation-leading change that we proudly stand by and, more importantly, improve on today. That was the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Bill 2015.

This was the first time that an Australian state enshrined nurse- and midwife-to-patient ratios into law. I want to take a moment to quote a few lines from the then Minister for Health, the Honourable Jill Hennessy, because they are so relevant in today’s context:

This bill is an Australian first.

It will help nurses and midwives do what they do best, it will guarantee every Victorian patient the care they need and it will protect the integrity of our highly respected nursing profession in the future.

She goes on to mention that:

There is evidence … that if a nurse has more time to provide care to a patient, then the risk of that patient having an unintended complication or event – like falling or developing a pressure ulcer – is far less than if the patient was left unattended.

In essence she was highlighting the incredible work that our nurses and midwives do and how through appropriate legislative frameworks government can support the incredible contribution that they make to our state. Members may note the distinct similarity between the titles of that piece of legislation and the bill that we are debating in the house today, and that is because the Allan Labor government is building on the progress that has been made by ensuring stronger and safer ratios. We recognise there is always more to do to improve patient and carer safety and satisfaction, and it is critical that we institute better nurse- and midwife-to-patient ratios to ensure the best possible care for Victorian patients and their families. We made commitments in 2014, and we delivered them through the legislation I began my contribution with. We also made that commitment again at the 2018 election and delivered them. Now we are once again delivering on our commitments made at the 2022 election. It is already our third round of improvements to legislated minimum nursing and midwifery staffing levels in public hospitals, a record we are very proud to stand on.

Part of our promise to improving the quality of our health services in Victoria was to deliver a broad package of additional care and support for patients. Through this we will deliver extra night duty staff in high dependency units and coronary care units, an additional 457 nurses and midwives into the health system, 30 more residential aged care nurses, the recruitment of 141 midwives and the trial of a neonatal support nurse in maternity wards. These are broad-ranging changes which in part have come about thanks to the continuing and ubiquitous advocacy of our nurses and midwives, and we are proud to stand alongside them because we have their backs.

I quote from Lisa Fitzpatrick AO, secretary of the Australian Nursing and Midwifery Federation (ANMF):

… the … Government has demonstrated once again it is really listening to nurses and midwives to recover from the pandemic and improve the system for all Victorians.

This government also understands that to deliver on these commitments, we need to recruit more nurses and midwives. As the demand for services gets higher, it is important that we address the pressure that is placed on the workforce. They are making an honourable and commendable decision choosing to serve public patients in public hospitals, and it is only right that we continue to encourage them in their career aspirations. Since we have come into government we have grown our healthcare workforce by nearly 50 per cent, with a 6.7 per cent increase just last year alone. In real numbers that is an additional 40,000 nurses, midwives, doctors and allied health professionals and other hospital staff. That is 45 per cent more nurses and midwives and 78 per cent more doctors serving in our public health system, and importantly nearly a quarter of these new positions have been in rural and regional areas.

A $270 million investment has been made for studying in nursing and midwifery to be free, an incredible initiative to build the supply and capacity of our workforce. This stands alongside how at the last state election we promised a $5000 sign-on bonus to those nurses and midwives who chose to enter Victoria’s public health system, and I do go to a very close friend of mine who in her 30s decided to go back and study nursing. Unfortunately she started her course a year before she was able to actually get that sign-on bonus, but she is now looking after patients, working in our public health system, and I thank her for the work that she does as well. The 2024–25 budget increased its investment into building Victoria’s public health workforce with an additional $183 million, and there has been an over 50 per cent increase in the paramedic workforce since we came to government. Furthermore, Lisa Fitzpatrick of the ANMF also makes important notes about the fact that increasing the numerical number of staff alone is not good enough.

There must be legislative action to address issues pertaining to staffing levels, rostering and workload management, and that is exactly what this bill goes through.

I want to make note of a few of the new ratios and regulations that will now be set in Victoria: one-to-one nurse-to-occupied-bed ratios in ICUs on all shifts; ICUs will be required to have a team leader and liaison nurse dedicated to them for the very first time; improved staffing ratios in resuscitation cubicles in EDs on morning shifts, down from one-to-six to one-to-four midwife-to-patient ratios in postnatal and antenatal wards on night shift; and in-charge nurses on night shifts in standalone high-dependency units and coronary care units.

We are already seeing the benefits of this government’s record investment in our healthcare system. Victoria is ahead of every other state in its planned surgery turnover rate, and we are the only jurisdiction that has performed planned surgeries within clinically recommended timeframes for all category 1 patients, category 1 patients being those that need immediate treatment.

I was delighted to join the member for Box Hill and the member for Ashwood in welcoming the Minister for Health to the Blackburn Public Hospital. For some context, in 2021 this government converted this site from a privately run operation into a publicly run facility now operated by Eastern Health. This year alone it will deliver around 4000 additional surgical procedures and 10,000 medical consultations. It is only through decisive and reforming government agendas such as this that we have seen the waitlist decrease almost 10 per cent compared to the same time last year, and that is partly thanks to our $1.5 billion COVID catch-up plan for surgeries that were delayed. Almost 50,000 patients underwent planned surgery in the last quarter, resulting in the lowest level of Victorians waiting for planned surgery since the beginning of the pandemic. The median treatment time in emergency departments is down 8 minutes to 14 minutes, a significant improvement as a result of direct investment into this incredible healthcare workforce we have here in Victoria. I have so much more to talk about, but time is getting – an extension of time, member for Kew? No?

We know just how much of a difference these changes will make in supporting our incredible healthcare workforce to deliver safe and high-quality care for all patients in Victorian hospitals. I am proud of the work that the Allan Labor government is doing to protect and support Victoria’s public healthcare system. I want to thank all the nurses and midwives for everything they do for the people of Victoria. I commend this bill to the house and wish it a speedy passage.

Nina TAYLOR (Albert Park) (16:37): This bill is really about backing in the nurses who do incredible work day in, day out to support the Victorian community. We are extremely proud of them and grateful for their dedication to us.

I will, before I proceed, just do a little shout-out to my great-aunt Lois. She is in her 80s. She is incredibly resilient, mighty and amazing. She was a psychiatric nurse, so I want to commend her for her dedication to community as well.

Moving on, what I did want to say to start with as well is, thinking about some of the reflections that have been shared in the chamber, that there are so many qualities that nurses need. Fundamentally, when we are talking about health, it is such an incredibly vulnerable part of humanity, and that is why we are so reliant on a well-trained, highly skilled and compassionate workforce. That is why the least we can do is back them in, and this bill reflects listening to those people who do this hard work day in, day out for us and reflects the needs that they have genuinely shared with us. We are, after all, the party of nurse-to-patient ratios, but it is after listening to the nursing profession that we are bringing about what is actually an incremental set of really important reforms.

I was even reflecting back on when my late father’s illness was unfortunately not going well, back 30 years or so, and I was thinking about the vicissitude of emotions that nurses have to deal with. Obviously they get to at times deliver some really beautiful news, particularly when they are able to deliver a new baby and hopefully all is well – that is also not always going to be the case, as has been shared in the chamber. But they also have to take the family on the journey.

What I remember of the nurses in a very compassionate and caring but pragmatic way is they were able to ground us and to let us know that my late father’s days were not going to continue, that there was an end point, that there was a failure of organs, and it was certainly not the information I wanted to hear, but nevertheless it was necessary. Somebody had to share that, to ground us, to prime us and to prepare us so that we could at a certain point in time – and that is what grief is about – learn to cope with that. I am incredibly grateful, because imagine having to share that kind of information and to deal with that – and this is not just a one-off.

Surely they are having to deal with these very awkward – well, ‘awkward’ is understating it – and these very emotive situations, and they are expected to handle it. I am incredibly grateful, because as I say, at the time when I heard the words ‘Your dad has three days to live,’ I did not want to hear that. I was like, ‘No he doesn’t! He is not going to – that’s not what I want to hear.’ I mean, I did not say that to them, but in my head I was thinking that was absolutely not the information I wanted to hear. But it is exactly what I needed to hear, and mainly for my mum at the time and my brother, so that we would be able to cope, because actually the thing that human beings find the most difficult – and this is perhaps the most striking thing about acute scenarios when you are talking about accidents et cetera – is surprises. We want to be able to deal with situations, and the best way we can is if we have forewarning, if we have some way of planning ahead. Emotionally this is just the way human beings are, generally speaking. Some will adapt more quickly than others, but then there is having that courage – because I think it takes real courage – to be able to share with that kind of candour the information that people need to hear.

So when I was thinking and reflecting on this bill, I was reflecting on the dexterity that we expect of the nursing profession and are incredibly grateful for. They perhaps in many cases take that in their stride, because as I know the member for Hastings was saying, it is not like an incident has occurred and that is it, that everything else will be simple. It is continually challenging, and I think that really requires a certain disposition that is able to get up each day and to face the necessary fight that is required to keep human beings as healthy and happy as possible.

I did want to start on that premise because I think that fundamentally underpins the purpose on which we are passing these incredible reforms today. I am not saying ‘incredible’ in terms of ingratiating ourselves; I am saying they are incredible because of the very important purpose that they serve for the broader Victorian community, because they will ultimately benefit as a result of improved nurse-to-patient ratios. Fundamentally the nurses will too, because then, yes, it is great, we gift them these terrific skills and training. Well, they do the training, I should say. It is not that it is given. It is something that they do through their own hard work, endeavour and study, but ultimately if we then lean on them and say, ‘Okay, well, we expect you to deliver,’ then we need to back them in, right? That is what today is about. It is really backing them in to do what they do so they can do it, because it is one thing to require certain outcomes, it is another thing to actually give them the pragmatic elements that enable them to attend to the requisite number of patients that are presented on any given day.

Therefore I think that further to some of the commentary regarding this hospital not getting this or that or the other, well, of course you have always got to be advocating for your particular hospital or otherwise – granted – but this today is about the nurses themselves and about saying, ‘Yes, we recognise wholeheartedly how hard your job is, how much each and every Victorian is vulnerable and requires that skill, dedication and compassion, and in return we want to make sure that you have the ratio requirements that enable you to meet the demands of your roles.’

I do want to say in terms of the investment, just to be sure that people are clear that we actually have backed them in properly, that the government committed $101.3 million in the 2023–24 budget to support the implementation of these new ratios. The new ratios build on the Labor government’s 28.4 per cent pay increase for our hardworking nurses and midwives, helping to retain and recruit more nurses so more Victorians can get the very best care, which is what it is about.

We are also recognising through this deal the undervaluing of this highly feminised workforce. It is also an important step forward, and I think it is thematic today and this week as we are celebrating International Women’s Day – which is sort of International Women’s Week, which is quite right, or month, as is appropriate – to be able to encompass all the different aspects of what that means. It is an important step towards gender wage equity in Victoria, and that really counts for something, to say the least. So that is also a really important stride forward, and it is a commitment we made to the Victorian community. Because when we are talking about tackling equality, tackling fairness in the workplace and also tackling relationships and making sure that we have that respect, whether it be in our schools or whether it be in our homes, we also have to stump up and show it in our workplaces as well. This is just another way that our Victorian government is actually – it is beyond a signal, but let us say at a minimum – sending a strong signal of what we expect when it comes to quid pro quo, which is people putting in, we back them in too, but also we make sure that there is true equality between the males and the females in these circumstances as well.

I should say, further to the point about us backing them in, that since we came to government we have grown our healthcare workforce by nearly 50 per cent. That is an additional 40,000 nurses, midwives, doctors, allied health professionals and other hospital staff in our state’s health service. Almost one in four of these new roles has been created in rural and regional Victoria. I know that has been another theme here today, and I want the chamber to be clear – and I think on this side we are clear, but just for the other side – that this is not just about metro Melbourne. The nearest hospital for my electorate is the Alfred, by the way. This is for the benefit of all Victorians, or otherwise why would we be doing it?

There are now 45 per cent more nurses and midwives and 78 per cent more doctors in our hospitals than when we came to office. They are not subtle figures, and neither should they be. They are reflective of the needs of our population, but they also reflect the fact that this is not just lip-service and that we have taken real action, just as we are doing here today. It is truly an honour to be able to be part of a caucus that actually backs in our nurses.

Tim RICHARDSON (Mordialloc) (16:47): What better way to bring home the bills this week than to finish off on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. When we saw the government business program come out earlier in the week, I thought this would be one at the end, back into the program, the chamber would be up and about and we would have the speaking list just running down the street. But now we have seen that the part-timers on that side, the coalition, have just gone home. I do not know where they are around the precinct. The de facto leader of the Liberal Party over there, the member for Kew, is holding the fort and the new member for Prahran is doing the time, but I do not know where anyone else is. Where have they gone? Because this is such a significant bill to put forward in our in our state. Importantly it is around the nurse-to-patient ratios and about safety and care for Victorians. I am just amazed at the contributions that have been made, the care and empathy and respect that has been shown to our nurses and the lived experience and the living experiences that people have shared and their most important moments and how they have connected with our nurses and midwives over their journeys. I have said this before: they are truly the best Victorians in our state.

Recent times have seen such significant challenges. When we came to government it was the threat of further industrial action, the undermining of their ratios, having to fight with the former coalition government and knowing that they would never have a safe day under those opposite. When they strip away nurse-to-patient ratios, when they try to bring in health assistance and when they try to privatise elements of our health service, we see the impacts on patient safety. Then when we were at the absolutely critical juncture of a one-in-100-year pandemic, where it was shoulder to the wheel and life was at risk left, right and centre, we saw nurses and midwives front up and answer the call in some of the most dangerous circumstances that we have seen and in uncertainty. Remember that when we had very little knowledge around what this pandemic would be it was nurses and midwives that ran to a crisis and risked their own health and wellbeing and safety, and who fronted up in PPE and made sure that they were supporting our communities in the most vulnerable, difficult and dangerous times. At the same time in 2020 we had those opposite undermining health messages, undermining the safety of our health workforce like we have never seen before, peddling conspiracy theories and pandering to populist and far right groups that were trying to undermine the work that they were doing.

Yes, there were concerns and discussions around the pandemic and challenges during that time, but those that suffered most from some of the undermining of the chief health officer and the health messaging at the time were our health workers in that system. That shows that when the going gets tough those opposite will take the populist view rather than support the health and wellbeing outcomes of our nurses and midwives.

It goes back to behaviour that we have seen before. Past performance is a good indication of what the future might hold. I remember vividly the coalition breaking that 2010 election commitment around maintaining ratios. I remember that image of Marshall Baillieu at the time as the nurses were campaigning for better rights and outcomes. He literally gave the middle finger to those nurses and midwives at that time, in some of the most arrogant behaviour that we have seen. Then we saw the health minister at the time absolutely trying to pulverise our health system. Our paramedics were at war with that government. The health workers that we saw, our nurses and midwives, were pleading for patient safety and those outcomes. Luckily they have got a Labor government that listens and backs them in. A 28 per cent pay rise recently acknowledged the work that they do each and every day to create a healthier, safer and more supported Victorian community. To see those nurse-to-patient ratios enshrined in our laws and then most recently built upon, strengthened and protected into the future is just a magnificent legacy of the Andrews and Allan Labor governments.

It was a really stark image during the 2022 campaign. Remember there was a lot of coalition rhetoric around health and what investments they would make, but there was a stark absence in some of the media and some of the publications. Remember those images of the member for Bulleen, then Leader of the Opposition, standing out the front of health services along with the member in the other place, Georgie Crozier, out on the lawns, not with any health workers – no nurses or midwives anywhere near them. They would have a group, a gaggle – you might say a ratio – of Liberals out there, but no health workers wanted to stand shoulder to shoulder with them. When the then Premier Daniel Andrews announced more support for nurses and midwives, it was literally an elevator of health workers who came together because they knew in every instance, in every week, we would be supporting and backing our nurses and midwives.

These values are all choices that we make when we are in government. What do we value, what do we support and what do we protect? It is one thing for members to come in here and talk about some of the challenges in health in their communities. That is important narration and an important thing to put on the record. But it is a long way from what this bill actually talks about. It is a long way from narrating whether they are supportive or opposed – whether they would apologise on behalf of their constituencies for undermining health messages in the past and then do the honest thing, say that they have not supported health workers in the past and front up to the consequences of their decisions.

We have invested more than $100 million to realise these reforms, and we have seen some 40,000 health workers, our nurses and midwives, added to the Victorian care, support and health economy over this time. That is an extraordinary number and uplift of people who have chosen a career in this sector, and their contribution is one of the best that you can make in our state into the future. They have chosen this as a pathway, and we have facilitated that through some better pay and conditions outcomes and some safer ratio outcomes. Those changes are the gold standards leading the nation, the values of the Victorian Labor government, and we are seeing some of those values then followed up by governments in other states and territories as well. Leading the way means that health workers across our nation are getting a better outcome for some of the policy work and the efforts that were made back in 2015 when we came to government and built on year after year after year.

I want to give a big shout-out to Australian Nursing and Midwifery Federation Secretary Fitzpatrick. The work that she done has been absolutely extraordinary in leading our nurses and midwives during that time to really embed these ratios and changes into the future.

It is also worth thinking of where we would be if we had not had those ratios in place during some of the most difficult challenges – through the impacts of the pandemic and going through the elective surgery wait times that we have seen a decline in, with people getting the necessary and important surgery outcomes to support them into the future. Where would we have been had we not had those ratios in place? Where would we have been if we not had that support?

Everyone has a key lived experience of their engagement with nurses and midwives. I can speak from experience – not as eloquently as the member for Hastings, who gave such a beautiful account of how nurses and midwives have supported and engaged his family in the past. I give a shout-out to your daughter, who has such an amazing story with EDS and the work and advocacy that she is doing and the engagement that she has with health professionals. The midwife discussion you had really touched me because my partner Lauren went through two emergency C-sections to have our daughters Paisley and Orla, and that had a mental health and wellbeing impact and she went through postnatal depression during that time and that impact. It is the care and the nurture and the support that midwives provide that makes that journey easier, that makes the outcome and the recovery during that time a little bit easier. The care and compassion that they show are some of the most amazing things that we see – some of the greatest examples of care and humanity. It helped Lauren on her journey, recovering after Paisley and then into Orla as well.

When you think that nurses do that and front up. One of our best mates – Ebony, whom I will give a shout-out to – in our community fronts up in some of the most dangerous circumstances for mums delivering babies. Sometimes they have the most tragic circumstances and outcomes. She will go from the most elated joy in a moment all the way through to some of the deepest despair that parents go through, and she fronts up to double shifts to do that and does it each and every day, works overtime, works night shifts and fronts up, supports her family and then goes again. She asks me sometimes, ‘Oh, how has your week been?’ I go, ‘I sent a few emails,’ and she goes, ‘I delivered a few babies and supported some parents through some traumatic circumstances.’ I go, ‘You’re one of the greatest of all time.’ That is just an example of one glimmer of what midwives do in our communities and why we love and appreciate them so much in everything they do, and we give them a big shout-out. It is not just about words though, it is about actions. For a decade now this Labor government has backed nurses at every moment possible, with the most outstanding health minister we have had in Victoria, the Minister for Health, who does an extraordinary job. We commend this bill to the house.

Matt FREGON (Ashwood) (16:57): Safe patient care and nurse-to-patient and midwife-to-patient ratios – are we proud of this or what? It is great to see the opposition is supporting us. I have got a little bit of time, and I just want to give a shout-out to the late Jan Kennedy, who was a power of strength – a midwife and all-round community health worker – for many, many years in our patch. I know that if she was still around today, she would be so proud that this bill is, hopefully, about to be passed in about a minute. It cannot be underestimated, the advantage of having these ratios, and I will give a quick example. We all remember the worst of COVID, and we all remember there were some terrible stories about patients in private aged care. A lot of people lost their lives. Do you know how many people lost their lives in state aged care? Zero. Now why would that be, I wonder. Well, part of it is nurse-to-patient ratios – standards that this government expects from our public servants. If you want a reason – and again, I appreciate that the opposition are supporting this bill; this is great – we can all agree that nurses–patient ratios in the wards support us. I do apologise to the nurse about 12 years ago that I gave a hard time to when she wanted me to walk after an appendix incident. I might have given her a bit of lip, and I deserve what I got back, by the way – so apologies for that. This is a fantastic bill. I am very excited to vote aye on this. I can only thank the Minister for Health for her work on this bill, and I commend it to the house.

The SPEAKER: The time set down for consideration of items on the government business program has arrived, and I am required to interrupt business.

Motion agreed to.

Read second time.

Third reading

Motion agreed to.

Read third time.

The SPEAKER: The bill will now be sent to the Legislative Council and their agreement requested.