Wednesday, 29 May 2024

Health services

Georgie CROZIER (Southern Metropolitan) (10:19): I move:

That this house:

(1) notes that in relation to the proposed amalgamations of Victoria’s health services:

(a) several media reports have confirmed that the Victorian government commissioned a report to address the growing financial issues in Victoria’s public hospitals and potential solutions;

(b) the Secretary of the Department of Health Professor Euan Wallace confirmed at a hearing of the Public Accounts and Estimates Committee on 22 May 2024 that a report was provided to the Victorian government in early May 2024 around the issue of hospital consolidations; and

(2) requires the Leader of the Government, pursuant to standing order 10.01, to table in the Council by 19 June 2024 all briefs, advice and reports provided to the Minister for Health and to the Department of Health around recommendations, practical implementation and feasibility of amalgamating, consolidating or merging, however described, Victoria’s health services in both regional and metropolitan areas.

This is an important motion because there is so much uncertainty within the community around what is going to happen to our health services. We know that the government did a review of the health services plan in December 2022, and in that review at the time it did have suggested health service partnerships. They are highlighted into eight areas with eight lead hospitals, and in those areas it showed where hospitals would fall and how that would happen. For instance, north-east metro, under the lead of Austin Health, had Eastern Health, the Mercy Hospital for Women, Northern Health, St Vincent’s Hospital, the Royal Victorian Eye and Ear Hospital and Forensicare. In south-east metro Monash would be the lead and it would be responsible for the Alfred, Calvary Health Care Bethlehem and Peninsula Health, and the list goes on. I will not, in interest of time, read those out, but the point is this is what the government was planning or had advice to do.

We know in the minister’s letter of 8 May, just after the budget was handed down, that she made it very clear to CEOs and boards that the department had set a form of directives and that she would operate under the act to ensure that the government’s direction was followed through. That letter says a number of things. It states:

… the 2023–24 Statement of Priorities, provides immediate financial support to ensure that your health service has the necessary liquidity to fulfil its short-term obligations. The specific level of financial support and the resulting operating target allocated to your health service for the 2023–24 period is also outlined in your Statement of Priorities. Financial support is provided based on forecast financial information, and no further funding will be provided.

There is a lot of uncertainty for many health services come 1 July, and that is in just a few weeks time. What this documents motion is very reasonably asking is for the report that Professor Wallace referred to, which the department has, to be released in the interests of transparency and certainty for these health services.

There is a loss of service already happening since the amalgamations. With Kyneton into Northern people have had their surgery cancelled and been told, ‘That hospital now doesn’t conduct that,’ so they are on this extended waiting list. This is happening now. The CEOs, those people that support the hospitals and the communities themselves have been completely left in the dark by the Allan Labor government in relation to their plans to amalgamate services, and that is not good enough. This is a simple documents motion in relation to what I think the entire Victorian community deserves to see, and I would urge that the government provide the documents within the timeframe I have set out.

Michael GALEA (South-Eastern Metropolitan) (10:23): I rise to speak on notice of motion 438 put forward by Ms Crozier in relation to certain documents pertaining to health services in this state and, I note, throwing out hypotheticals that Ms Crozier has done and making assumptions and assertions –

Georgie Crozier: What, are you saying that services have not been lost?

Michael GALEA: I think it is timely, and I will pick you up on that interjection, Ms Crozier. I am happy to reference the incredible investment that this government has made in health services in this state over the last 10 years and indeed in this year’s budget, with $13 billion in this budget and the $8.8 billion investment that we have also seen into our state’s hospital system.

I note that Ms Crozier’s documents request comes in light of comments made at the Public Accounts and Estimates Committee hearing on 22 May, last week. As I mentioned yesterday, it was good to have Ms Crozier in the room. I cannot say that too many of her colleagues in the shadow cabinet did attend. A few did, but not too many. It was good to at least have you there, Ms Crozier, and you certainly made your presence known and heard as well. It was good to see you there.

What I would say is that this is a government that has delivered and invested in Victoria’s health system in metropolitan Melbourne and in regional Victoria and will continue to do so. We will continue to do so in a way that is putting patients first and making sure that patients are supported and looked after as much as they possibly can be. For me to come up and say this, I do so on the back of significant investment and significant reforms that have already been made. If you look at the 18-month period just up to March 2024, we have seen 274,000 patients pass through our innovative virtual emergency department. That is 274,000 people either not contributing to a wait at their local emergency room or indeed getting that health care that they might otherwise not have taken up. The virtual emergency department is an incredible initiative, and I strongly encourage all Victorians to take it up.

We also of course remain a nationwide leader when it comes to women’s health, and we have got the pain inquiry which is underway right now and which has already received well over 7000 responses. In this place of course I have already talked about the priority primary care centres, where again, the state government is stepping in to fill the void of a lack of investment that we saw after nine years of chaotic coalition federal government. We are investing by providing free nursing degrees to people that want to take up the vocation in this state as well as attracting nurses and doctors from overseas. You only have to look over somewhere like the UK and look at their papers to see constant reports of their National Health Service doctors and nurses leaving the country, again under conservative mismanagement. They are coming to Australia, coming to Victoria in particular, because they have spent 14 years under a conservative government and they know what it is like to go through that underinvestment.

Ms Crozier referred to regional health services as well. Whilst I can point to the huge number of hospitals that have been either built or significantly expanded by this government from metropolitan Melbourne through to regional Victoria, I could also of course point to the three private hospitals that have been purchased to be converted to state surgery centres – in Frankston, Bellbird in Blackburn and in Mildura. But also if you were to go and ask people in Eildon, in Koroit, in Mortlake, in Murtoa, they would tell you that it was a coalition government that closed their hospital. It is the same if you ask people in Red Cliffs, in Macarthur, in Clunes, in Beeac, in Birregurra, in Lismore, in Elmore and in Waranga. These are all towns across Victoria that have suffered from cuts and closures to their hospitals under previous Liberal–National coalition governments. So regional Victorians, particularly in these towns, see through these attempts by Ms Crozier, they see through the deflections, because they know that this is a government that has invested and expanded in our state’s metropolitan and regional hospitals whilst those opposite only have a reputation of closing them. So for this reason, whilst I will not be opposing the motion today, I point out the sheer hypocrisy of those opposite when they try and lecture anyone else in this place on their record on health.

Sarah MANSFIELD (Western Victoria) (10:28): The Greens will be supporting this motion, both on transparency grounds and more fundamentally I think as an issue that really does need some more robust public discourse around it. Amalgamation or consolidation of hospitals is clearly on the government’s agenda. It is one of the worst kept secrets, I think, in this state at the moment. It has the potential to be one of the biggest health reforms this state has seen in decades, and yet there has been almost no genuine public discourse about this issue from the government. As someone who cares deeply about our public health system, this is really concerning. Instead what we have got are leaks, press reports and rumours, and that has left many health services and communities, particularly in rural and regional areas, uncertain and jumping to conclusions about what this is going to mean for service access in the future.

People are particularly fearful that this is going to lead to the closure of services, again in rural and regional areas. This fear makes sense, because it is logical to think that an amalgamation will lead to efficiency drives and in turn services will be cut to areas where it is most expensive to provide care, typically in rural and regional areas. We know that providing those services can be more expensive and that at least in theory with scale and in larger services these services can be delivered more cheaply. So it is understandable, this fear that is out there. The reality is there may be certain services or aspects of the health system that would benefit from some consolidation or amalgamation, but we are yet to hear any clear rationale from the government as to why this needs to be done or to justify the way they propose to go about this based on the information that is being leaked out there. Is this about saving money? If so, what modelling supports this? Open up the conversation. Talk about it. Provide this information. Provide a justification. There is plenty of commentary out there that would challenge the idea that amalgamations save money, particularly amalgamation of smaller hospitals. You might save, in the long run, some money by amalgamating larger services, but what it fails to recognise is that you need to make a huge investment up-front to undertake a health reform of this scale. But there has been no conversation about that.

Perhaps it is about improving service delivery. Again, if this is the basis, where is the evidence? It is possible that amalgamations could deliver better services for some regions, but it is difficult to know whether this is what is driving the government, because they are not being open, they are not talking about this. Perhaps it is just simpler to have fewer services. We have over 70 services. It looks nicer on paper if you have got fewer of them. But I think we need to be striving for more than something that looks good on paper. An arrangement that can be carved up neatly ignores existing partnerships, referral pathways and community-health-seeking behaviour that exists within our community and works really well.

There is much more to be said about this subject, but in essence we believe that such a significant reform with the potential for far-reaching consequences deserves far more transparency and public discussion than what we are seeing from the government at the moment. I really would encourage the government not only to release the documents being called for here but to start being more open about this agenda around health service amalgamations. The information is already getting out there in the public, and I think you would do yourselves a service to start providing a really strong rationale to the public for why you feel this is the pathway we need to be going down in Victoria.

Ryan BATCHELOR (Southern Metropolitan) (10:32): I rise to speak to Ms Crozier’s motion in relation to Victoria’s health services and seeking some documents. I think it is pretty clear from the track record of this government that we believe in our health system and we support our health system. The fundamental purpose of our health system is to give Victorians the care that they need. That is what our health system should be providing. That is what the priority of our health minister has absolutely been focused on. Victorians deserve a health system that is delivering them the care they need in the right place at the right time. As the Minister for Health has said repeatedly, the purpose of the health services plan, which this motion seeks further information about, is to understand the challenges facing our health system and, on the advice that that plan is giving the government, how we can best maintain the optimal design of our public health system so that it is doing that focused work on patients.

Obviously Victoria and Melbourne have changed and continue to change dramatically. We have seen that in the communities that we represent – the changes that are flowing through our communities, who lives where and the issues that confront them. It is only a sensible and prudent thing, particularly when we are looking at how we can provide the communities we represent with the care that they need, to be continually looking at how that system performs. That is exactly what the health minister is doing with the health services plan: focusing on the patient outcomes that we need.

But it has been very clear – the minister has been very clear – that, unlike the Liberals, the Labor government will not be closing hospitals. The Labor government will not be selling off hospitals. Unlike the Liberals, we will not be privatising our hospitals. Our record is one of investment – putting money into the front line where it is needed. $13 billion in 2024–25 will support the delivery of world-class health care in Victoria and the provision of better healthcare facilities for Victorians wherever they live. That is just one budget on top of years and years of budget investments in our healthcare system.

As has been previously mentioned in the debate, our government has an outstanding track record at building new hospitals, at upgrading our existing hospitals, of buying privatised hospitals and putting them back into public hands. That is what we did in Frankston, that is what we did at Bellbird and that is what we did in Mildura; we took hospitals that had been privatised or were private and brought them into the public hand. What we are doing now is ensuring that the health system overall is best structured, is best designed, to be focused on meeting the ever-changing healthcare and patient needs of Victorians. That is absolutely what we are doing. This health minister is focused on ensuring that our healthcare system is delivering Victorians the health care that they need, that it is focused on improving frontline services and focused on improving patient outcomes. We are interested in what goes on at the front line as the absolute, most important thing that should be determining how our healthcare system operates and ensuring that the way that the system is organised, the way the system is focused and structured, is absolutely designed to meet the emerging and ever-changing needs of Victorians and their health care. For that reason we think the health minister, particularly in this area, is doing an exceptional job.

Motion agreed to.