Thursday, 6 February 2025

Bills

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

Second reading

Debate resumed on motion of Gayle Tierney:

That the bill be now read a second time.

Georgie CROZIER (Southern Metropolitan) (10:03): I rise to speak to the Drugs, Poisons and Controlled Substances Amendment (Paramedic Practitioners) Bill 2024. This bill is another important bill that has come before the house in terms of providing health care and providing support to healthcare frontline workers in this state. As you all know, in terms of what I have said about our health system in Victoria, it is in crisis. It remains in crisis. There are issues right through the system. There are workforce issues. There are cultural issues with various organisations, and I will come to that in relation to Ambulance Victoria with the latest Victorian Equal Opportunity and Human Rights Commission report. There are issues around infrastructure and ability to build. With the latest report that will be tabled, I have seen that there are just so many problems with this government’s ability to manage budgets properly – the blowouts, the waste – and that ultimately leads to issues with the ability to deliver health care.

What this bill does is it amends the Drugs, Poisons and Controlled Substances Act 1981 to establish paramedic practitioners as a class of registered paramedics and to authorise paramedic practitioners to obtain, possess, use, sell and supply certain substances. I understand and I am aware that this was a commitment of the government at the last election, given the intense lobbying from the union that the scope of practice be expanded for paramedics. That is what the election commitment was about. That is why we are debating this bill today, and that is what the bill goes to. It expands the scope of practice for paramedics to be able to administer and prescribe certain drugs.

I want to go through a little bit of that. What the bill aims to do is allow paramedics, with additional training and extending that scope of practice that I have mentioned, to assess, diagnose, administer medication, treat patients on site, make clinical decisions and prevent the transfer of a patient to a hospital if they do not need to be transferred to a hospital. On the face of it, I completely understand them. I completely understand why the government would see that this was a good utilisation of expertise within the system, of the paramedics within the system, because as we know we have got extensive ramping. Ramping is occurring across the state outside hospitals as I stand here right now. That has not changed.

There are delays and issues right through the system. The government is looking at that. They are amalgamating hospitals and forming networks. Those issues will still not resolve the lack of action on addressing the health needs, which were before COVID very substantial. The elective surgery waitlist before COVID was at record levels. We do not have the latest data; it is well overdue. It was due on Friday. The latest Victorian Agency for Health Information data had not been made available the last time I looked, an hour ago. It was still reporting on the quarter from July to September of last year. We do not have September to December data, and it is now February, for goodness sake. This government is completely incompetent in providing proper transparency and in providing proper solutions to those issues.

So what I say is the many issues in the health system were there prior to COVID, and of course they have been exacerbated through COVID, but despite the government’s assurances that all would be well, things are not, and patient outcomes are still very significant. The issues are having a massive impact on the ability for good patient outcomes. I spoke about this last week. I was alerted to somebody whose young child had been waiting in the system for years to have a tonsillectomy. They had not been able to attend early education and they are going to have their primary schooling delayed. This is a symptom and just a classic example of the failures within the system, where the system is failing right throughout. That example is a direct result. So they are back on the waitlist, and it is unknown when they are going to get their surgery. That is a classic example of the failures in the system.

What this bill does is try to prevent some people from attending emergency departments, where they are very busy because of examples like that I just gave. When they are so sick, they have got nowhere to go and they end up in emergency to try and get the attention that they need. Our emergency departments are just so overrun. I speak to emergency department nurses all the time. They tell me about the issues that they are facing. The very real issue of occupational health violence, which is at record levels, is very extreme. There are very concerning levels of occupational violence. This issue with the ED and the system being so clogged is just a failure of a government which has not addressed the many concerns that our Victorian community has. The government will crow about this role and say it is the first jurisdiction to introduce this system. There are other jurisdictions that have brought in things like assistant physicians and all sorts of other personnel to try and deal with various aspects of the failures in the health system. It is intended that the first 25 paramedic practitioner graduates will be deployed in rural and regional Victoria in 2026. That is because there are such huge gaps in rural and regional Victoria. My colleagues who represent those areas understand the shortfalls and the failures and the real impacts that their communities are experiencing. Sometimes tragic consequences have arisen as a result of a failed system.

I will not go through every clause, but I did just want to go through a number of the important clauses to highlight what the bill actually achieves. Clause 4 defines a paramedic practitioner as:

… a registered paramedic who –

(a) has completed a prescribed postgraduate qualification; and

(b) satisfies the prescribed experience requirements …

This qualification is completion of the master of paramedic practitioner, which is as I understand delivered by Monash University. What that will then enable one of these paramedic practitioners to do is to obtain, possess, use, sell or supply schedule 2, 3, 4 or 8 poisons. That is really the important part of this bill that we are discussing today, and I want to drill down a little bit into that and the concerns of some stakeholders that I have spoken. I will be asking in the committee stage about some of these issues.

Just to go back to the scheduling of the poisons, schedules 2 and 3 poisons are pharmacy medicine or pharmacist-only medicines such as local anaesthetics and analgesics that are commonly referred to as over-the-counter medicines. Schedule 4 poisons are local anaesthetics, antibiotics, strong analgesics such as Panadeine Forte. Schedule 8 poisons are probably the ones I want to draw attention to because of the issues that we have had with paramedics and schedule 8 poisons in the past. They require strict legislative control and are drugs such as opioid analgesics, pethidine, fentanyl, morphine, oxycodone, methadone, buprenorphine, benzodiazepines and ketamine. They are very, very powerful drugs, and they should not be allowed to be used freely without proper strict guidelines. The reason I say that is because IBAC back in 2017 undertook an inquiry into what was happening within Ambulance Victoria – Operation Tone – which was a special report concerning drug use and associated corrupt conduct involving Ambulance Victoria paramedics. The report specifically talks about this group of drugs – the drugs of dependence. The report states:

In this report, drugs of dependence refers to prescription medicines that have a recognised therapeutic need but also a potential for misuse, abuse and dependence.

Fentanyl, morphine, cocaine and … (MDMA) are all classed as drugs of dependence pursuant to Schedule 11 of the Drugs, Poisons and Controlled Substances Act 1981 (Vic). Fentanyl and morphine are also listed under Schedule 8 …

That is what this bill refers to – schedule 8 drugs, not schedule 11 but schedule 8 – but they are still very highly powerful drugs and drugs that, as the IBAC report found, could be misused, be abused and lead to dependence.

This, I think, is very important because a number of paramedics were stood down, a number resigned and a number went off to do ethical courses as they were found to be involved in this corrupt and wrong behaviour. I think that is concerning for the Victorian community given that we need to ensure that there are absolutely strict controls so that that sort of misuse does not occur again. I raise that because with those drugs, as I said, misuse can be very, very dangerous. Fentanyl, which is being discussed as a drug of concern around the world, is very highly potent and can be fatal on many occasions. We have seen tragic circumstances, and there are even more drugs coming into the illicit drug market, and people have just got no chance to even respond properly and get the care they need.

So there are some strict guidelines that are required around those schedule 8 drugs, and I think that obviously the government understands that, given that very important IBAC report that was done on the misuse and the corrupt conduct of those paramedics at the time. If you go back to what was reported on this very issue, it was around the security around the drugs. It has apparently been improved. But I note that the former CEO of Ambulance Victoria Tony Walker said it was ‘a wake-up call’. He said that the abuse that was going on was a wake-up call. I will quote him from an article from the Age in September of 2017:

He said that while the IBAC report focused on the actions of paramedics in the Barwon South region, that illicit drug-taking among ambulance staff likely occurred in other parts of the state.

So that is why I make mention of this very important issue, because it is only in recent years that this has occurred, and I think we need to be understanding that there are those safeguards in place for these paramedics that have got access to these schedule 8 drugs. What they are doing is actually – we are not going to have that situation arise again.

On that basis, clause 10 goes to a bit of that security around the issues around these very potent drugs and the access. Clause 10 enables access to the monitored poisons database, which contains records of patients’ prescriptions through SafeScript and supply history for high-risk medicines to paramedic practitioners. This is aimed at facilitating safer clinical decisions and preventing the misuse of high-risk medicines and drugs of dependence. I think that clause there is a very important clause, and I hope that it is there, as I said, in understanding of what happened just a few years ago with paramedics.

To move on to various stakeholders around their concerns with this bill. And there are concerns, and I will be asking in committee just to get on the record some of those issues that have been raised with me. Obviously the ambulance union is highly supportive of this bill. They put it forward. It is part of the government’s election commitment, and I have got no doubt that that was a done deal between the union and the government. But very important stakeholders such as the AMA and also the college of emergency medicine have got concerns around this bill. The AMA have stated that they understand that it is a government commitment, but they do have concerns around the expansion of the scope of practice and that it may have serious health implications for some patients.

I want to just tease that out a little bit more. The AMA, which obviously represents their body of doctors, say that they understand that there is a need for more timely health care delivery and access in rural and regional areas. They are well aware. The AMA Victoria president Dr Jill Tomlinson has spoken at length very eloquently about her concerns in terms of government’s approach to the networks, because she understands the access for rural and regional patients will be impacted by these amalgamations and mergers. They have an understanding and they believe that what this bill, in terms of these practitioners, will do is that it will conflict with the fundamental principle of delivering the right health care at the right location by the right person.

They talked about the case study that was on the department’s website – and when I was speaking I was getting some feedback. They talk about the case study presented in the consultation document provided by the Department of Health, which they say exemplifies this concern. The scenario which was provided to me was a paramedic practitioner managing an 82-year-old woman with diabetes and painful lower leg cellulitis. The paramedic’s role in stabilising the patient’s condition, educating her on potential complications and prescribing antibiotics raises significant questions about the appropriateness of such an expanded scope of practice. The complexities associated with diabetes management require a depth of knowledge and experience that typically falls within the purview of medical practitioners, not paramedics.

I am particularly interested in this case study. As a former nurse, a former midwife and a former diabetes educator I understand this area particularly well. I understand the very complex nature of the medical condition of people with diabetes and how it can impact significantly. I took up further study to get my ability to work with endocrinologists, physicians, ophthalmologists, renal specialists, obstetricians and dietitians so that I was part of that team to deliver the best possible care for somebody with diabetes. You have an extensive knowledge of how a person’s medical condition – their entire medical condition, as explained with this scenario – is managed, because having an infection can alter diabetes control very quickly and that can then lead to some very significant medical complications. As I said, having that knowledge and understanding and having dealt with many high-risk patients – these are often very high-risk diabetic patients – I understand just how sick they can get and how their comorbidities can be extended should the wrong management be undertaken.

I think the point of what they were trying to say was that an 82-year-old with cellulitis can be treated in their home and not be transferred into the emergency department. That is probably what the government and this bill is trying to get around, in terms of something pretty simple. However, I do take on board the AMA’s concerns around the complexities of some patients’ complex comorbidities and how that can impact their renal failure, their eyesight, their heart, their heart conditions and vascular conditions very, very significantly. For a diabetic, cellulitis is not a simple condition. It can be very serious if it is not managed properly, because the vascular damage done to someone by the disease of diabetes is very, very significant. I do understand why they picked out that particular case study, because I can just envisage what they are worried about. That is one aspect that I just wanted to highlight.

They also say that the expansion of prescribing rights to paramedic practitioners, including the authority to check SafeScript and apply for schedule 8 permits, exacerbates their concerns. They argue that those people accessing those schedule 8 drugs, as I have described before, should only be available for those that have appropriate medical training. Likewise, the Australasian College for Emergency Medicine understands that roles are expanding, but they would like to see proper supervision with this. They understand that there is room for scope of practice, and they support an extension of scope of practice with nurses and others in emergency departments, but there they have the oversight of medical practitioners. They make a very good case for saying, ‘Well sure, we understand that scope of practice can be extended, but you have that overall supervision which is undertaken in the emergency department.’

There has got to be some practicality around this. I will be asking about what the government intends in terms of reviews of this, how they intend to undertake a review process to ensure that it is working properly and that those issues that have been highlighted by the AMA and the college of emergency medicine are understood and that they are not exacerbating issues for patients. I think it needs to be closely monitored. I do not know how the government is going to do that or how they will actually be monitoring that or whether AV will be doing that. AV is in such chaos and a total mess; they have hardly got any capacity to be undertaking this. I want to understand exactly what will be happening in terms of the review and to see that some of these issues that I have highlighted actually do not occur.

In saying all of that, our paramedics do a sensational job. I understand that scope of practice too in terms of having that ability to do as much as you are legally allowed to do. As I said, as a diabetes educator I was doing a lot of diabetes management for those patients in close conjunction with the endocrinologists, physicians, obstetricians and paediatricians that I was working closely with. I do understand the scope-of-practice proposition and I am supportive of it, but I do want to understand also: when the paramedics are going through and this training is fulfilled and they are in the field, what will it look like? What will that review look like?

The other point that the college makes is they are unsure about the impact on emergency departments, and I want to understand what the government has in relation to that. They say:

The College is yet to see any evidence to suggest that the PP – especially with the number of positions, and the breadth of the health system they intend to cover – could possibly make any meaningful reductions to ED workload.

Because that was one of the pitches that the government gave, and I think that is something I will also be asking in committee, around what evidence you have and what impact is it actually going to have on the emergency departments, especially as there are only 25 rolling out next year. I am not sure when they intend to be rolled out and where they will be going. What areas have been identified as to where their greatest need is, and how will that impact emergency departments? I do not think it will have an iota of an impact on the emergency departments in metropolitan Melbourne, because they are overstretched, as I have explained. They are seeing increased numbers of people who are getting sicker. They are waiting longer to get their vital surgeries. They are getting sicker and they have been waiting. We warned about this years ago with the shutdowns of surgery, and it is all coming through. We are seeing it in children, we are seeing it in young adults and we are seeing it in the elderly. It is a very concerning picture when people cannot be treated on time and they are out of work. There are huge, huge pressures within households from the cost of living. We have heard about that in relation to cancer treatments, where people just cannot even take their loved ones to cancer appointments because they cannot afford to take time off work, and the Cancer Council is getting increased calls to their helpline. That is not new. That was happening at least two years ago when I was visiting the Cancer Council. They were talking about the impacts and the delays to surgery, and of course some of those patients also will end up in our emergency departments. This bill is not going to address any of those very significant concerns in the system. This is just really a bandaid measure. It is a deal done with the union. That is what this is about.

But nevertheless, I will be interested to see how the government thinks the bill will impact on our emergency departments, as has been raised by the college of emergency medicine. I would like to get some understanding from the minister about the consultation the government had with these stakeholders to allay those issues that have been raised with me – and I am sure they were raised with the government – and what the government has provided to them in assuring them that what they have raised will not occur. But again I say: I think there is a real need for a significant review of this when it gets rolled out.

With those words, I will leave it to others, but I am, as I said, interested in this bill. It is an important bill that we are debating today. There is merit in the intent, but there are also concerns, and I await prosecuting those issues further in the committee stage when we get to that.

Sonja TERPSTRA (North-Eastern Metropolitan) (10:31): I rise with great pleasure to speak about this very important bill today, the Drugs, Poisons and Controlled Substances Amendment, (Paramedic Practitioners) Bill 2024. It is really pleasing to see this bill now coming before the Parliament, because this was an election commitment of the then Andrews Labor government. It is always pleasing to see when we are in a position to deliver on one of our very important election commitments. We are a government who, when we say we are going to do something, deliver, and consistently what we promise we deliver. This is an important bill, particularly because we know that our paramedics do a fantastic job helping to keep Victorians well. It is a very important commitment that we made to them. Again, I just want to shout out to all the paramedics who work for us across the state keeping us healthy and safe.

This bill is an important bill because it also goes to, as I said, enacting the commitment and the promise that we made to paramedics that we would introduce a paramedic practitioner role. It is an important role, and it is one where we listened quite closely to what paramedics were saying they needed to do. It is an important piece of work because it will mean that it will ease pressures on our hospital system, and it will also enable people to get the care closer to where they are in their time of need. The Victorian government at the time, in 2022, committed to establishing and implementing a new paramedic practitioner role in Victoria in order to increase the recognition of this important workforce and address workforce shortages in these public and primary healthcare challenges, with at least 25 paramedic practitioner graduates to be placed in regional and rural Victoria by the end of 2026. As I said, it is important to recognise that people who live in rural and regional Victoria should have the access to health care that they need, when they need it. The paramedic practitioners will be able to assess, diagnose and treat patients in the field, with the aim of eliminating the need for a trip to hospital for many patients. As we know, this becomes critically important for people who live in rural and regional areas if they do not have access to a local hospital nearby.

As I said, this was followed by a public announcement of the initiative in June 2023 by the former Premier Daniel Andrews. To support the establishment of a paramedic practitioner role, the Victorian government committed to providing scholarships over four years, starting in the 2024 academic year. These scholarships are being delivered by Monash University and will enable registered paramedics who have at least five years experience working as a paramedic to pursue postgraduate studies with masters level qualifications under Australian Qualifications Framework level 9. So as you can see, the qualifications and the framework that underpin the role of the paramedic practitioners are second to none. It is really excellent training, which is required to support the paramedic practitioners so Victorians can have confidence in the level of care that they will be receiving from these eminently qualified paramedic practitioners. So I am really pleased to be able to speak on this.

There is also some other good news which I will just quickly touch on. A shout-out to Ambulance Victoria; I know Ms Crozier was quite critical of them in her statement, but I want to actually give a shout-out to Ambulance Victoria, because –

Georgie Crozier interjected.

Sonja TERPSTRA: Contrary to what Ms Crozier says it is actually not a mess, because what I can say is that just recently Ambulance Victoria and the unions reached agreement on the Ambulance Victoria enterprise agreement, and I can say that the turnout rate for people voting on this agreement was at 78.9 per cent. So what that actually means is that employees who work for Ambulance Victoria and our paramedics had confidence to turn out to the extent of 78.9 per cent. The voter turnout was extraordinary, because as a former trade union official I can tell you that some voter turnout on some of these EBAs is as low as 50 per cent, and that is always concerning, but there was such a high turnout, and 97.3 per cent of those people who turned out voted in support of the enterprise agreement. So what that tells me is that the workers and the workforce and Ambulance Victoria were able to reach agreement, which is what we actually want to see, despite all the negativity that comes from Ms Crozier over there. What we see is that actually workers and the employer were able to agree on reaching an important agreement that will see the delivery of tangible improvements for people who are paramedics, from their experience at work to how they are supported, to their salary and career, to work-life balance and mobility and to improved equity and access to conditions and opportunity. Now, that is important because we do not want people to leave. Often people go and work for an organisation like that, and burnout is a thing that often drives people away. So Ambulance Victoria is doing a great job in recognising and listening to their workforce and making sure they can get around the bargaining table and reach agreement on things that are important to their workers.

Also importantly the agreement recognises the need to deliver a better end-of-shift experience so more paramedics can leave work on time, because what was happening was that paramedics could not get home, they could not get home to their families and rest and recover. So this is an important agreement, and I congratulate Ambulance Victoria and of course importantly the unions – the Victorian Ambulance Union and the United Workers Union – for their collaborative and constructive approach to these negotiations. So the agreement is now with the Fair Work Commission, and hopefully that will be approved in due course.

So whilst Ms Crozier has been heckling me over there about how terrible things are, I have a sense of optimism about this, because what we have seen is this government, the previous government, made a commitment to make sure that we could get paramedic practitioners in the field to be able to deliver important health care to people where they need it the most. Despite what Ms Crozier says over there, what this will mean is it will take pressure off our emergency departments and provide much-needed access to primary and urgent care to those in rural and regional areas. And as has been previously noted, to implement its commitment the Allan Labor government has also invested $20.1 million in the 2023–24 budget. This is part of the work where we have established Australia’s first ever paramedic practitioners masters degree, as I said earlier, at Monash University, and we have 30 graduates who began in 2024 and a second cohort to begin early next year. So what that tells us is that those paramedics who saw it as an opportunity to gain further qualifications to work in the field, to undertake this important role, have taken that up with great vim and vigour, so it is great to see.

Paramedic practitioners are used in other international health systems as well around the world, in particular the UK, Canada and the Netherlands, so it is great to see that we are looking across the world to see what action we can take to make sure that Victorians have access to the best health care they can get access to in Victoria. So this work is on the back of our government’s strong belief that our healthcare workforce – in particular nurses, midwives and paramedics – should be empowered to work their full scope of practice.

So again I cannot state this point often enough, that we back in our healthcare workers, we back in our nurses and midwives, we back in our paramedics, unlike those opposite. When they were last in government they went to war with paramedics, they went to war with healthcare workers. What this government is about is making sure that we can deliver Victorians the best health care that we can offer them when they need it through our very important publicly funded public health system. We do not have people paying and selling their houses for health care here in Victoria, thank goodness for that. What we do is we make sure we encourage and enable those healthcare workers to get the qualifications that they need and pay them in recognition of the important work that they do. Unlike Ms Crozier, who wants to run down our paramedics and our healthcare system and our nurses, we are about lifting people up. We are about actually funding our healthcare system to ensure that people can get the health care that they need where they live and when they need it.

We have always backed our hardworking paramedics, and as I said, I want to thank them for everything they do every day. As I said earlier, we have invested $2 billion in our ambulance services and we have grown AV’s on-road off staff by more than 50 per cent, with more than 2200 more paramedics on our roads since the Liberals were last in office. Again, our commitment is obvious. We have supported our paramedics to respond to increased demand, with more than 1300 paramedics recruited over the past three years, and I have talked about those paramedics who have stepped up and taken the opportunity to now train as paramedic practitioners.

Despite the efforts of those opposite to talk down the work of our paramedics, according to the national report on government services, Victoria has more registered paramedics than any other jurisdiction, and that is something we are incredibly proud of. According to the same report, Ambulance Victoria’s response time is better than that of New South Wales, Queensland, South Australia and Tasmania. When those opposite were in government, Victoria’s ambulance response times were the worst on the mainland. And as I said, I think Mr Davis, when he was the health minister, delayed the release of data by up to 18 months. He did not want to talk about the delays that were going on when they were in government, because that is something they cannot manage. What we know is that things go to crisis, so when our government came in, we improved things, because we had a legacy of problems left by those opposite.

Within two years of coming to government, we ended the war of those opposite. You went to war with our paramedics. Our ambulance response times improved 80 per cent of code 1 cases to be within 15 minutes. They do not like the facts. They try to rewrite history and say how amazing they were, but no-one can rewrite that history. It was such a terrible history – a terrible, terrible history. David Davis tried to hide those poor times and data, and it took 18 months for us to actually get hold of them. Victorians should never forget how terrible it was and the cuts and the wars that were started with workers who were basically on the front line in helping keeping Victorians healthy and safe.

But we did not stop there when we came into government. In 2019, five months prior to the onset of the pandemic, Ambulance Victoria recorded their best ever response times, and we know our paramedics are dealing with record demand – demand 30 per cent higher than prepandemic levels. Despite this, the most recent quarterly data shows paramedics are arriving 16 seconds faster compared to the previous quarter. So you can see our investment and the ability of Ambulance Victoria to work with their staff have meant we have seen great improvement in the way that Victorians’ healthcare needs are being responded to, and that is something that our government is incredibly proud of. We will back in our important healthcare workers, paramedics, nurses and midwives every day, because we know that is what Victorians expect of Labor governments. We know that they expect to be able to access the health care that they need when they need it.

So to help our paramedics manage the demands that I recently spoke of, the most recent budget provided an additional $146 million to support a range of operational priorities for Ambulance Victoria, including medium-acuity transport services and expanding Ambulance Victoria’s secondary triage. This is an important commitment. Ambulance Victoria’s secondary triage system is one of the most advanced in the world and it diverts 20 per cent of 000 calls to alternative care pathways, because we know when some people ring 000 for assistance, they do not necessarily need an ambulance to take them to a hospital. So the secondary triage system is important and it can divert up to 20 per cent of 000 calls to an alternative care pathway. People are still getting the care that they need.

To assist our paramedics, we have also doubled the capacity of the Victorian Virtual Emergency Department, which has seen 400,000 presentations, with a diversion rate of over 85 per cent. That is incredibly important. Our virtual EDs are working and people have confidence in them, because they are using them. 400,000 presentations, with a diversion rate of over 85 per cent – that is critically important. Paramedics have a direct referral pathway within those virtual departments as well, which allows patients to be treated at home and avoids transfer to hospital and gets our ambos back on the road as well. We have strong ongoing support for Ambulance Victoria’s infrastructure. We have invested $279 million since 2015 to deliver 51 ambulance stations, providing better working conditions for paramedics and ensuring life-saving emergency care is available for all Victorians. I went and attended the opening of the Templestowe Ambulance Victoria station, which was closed under those opposite. We have made sure that we have got appropriate Ambulance Victoria infrastructure in those regions across Melbourne where they are needed so that paramedics can get out to the job when they need to and then they can get back to the station and be on call, ready to go again when that next phone call comes in.

As I said, we have reached an in-principle agreement with our paramedics around their EBA, which is with the Fair Work Commission now. That will see them remain amongst the highest paid paramedics in Australia. As you can see, our commitment to paramedics and our healthcare workforce is demonstrable; it is without question. As I said, I am really pleased to be able to make a contribution on this bill today. There are other government speakers who will also be making fantastic contributions. I just want to say again a big shout-out to our paramedics and our healthcare team, who do great work keeping Victorians healthy each and every day and help deliver the health care they need where Victorians need it. I commend this bill to the house.

Renee HEATH (Eastern Victoria) (10:46): I rise to speak on the Drugs, Poisons and Controlled Substances Amendment (Paramedic Practitioners) Bill 2024. I always find it very interesting listening to the government’s contributions. Sometimes they sound like they are talking points straight from the propaganda unit, which are ignoring all the facts, because let me tell you, there is a ramping crisis in this state, there is a healthcare crisis in this state and there are over 60,000 people on the surgical waitlist who are getting sicker and sicker while they are waiting extended periods of time. I find it a bit upsetting that rather than listening to Ms Crozier’s genuine concerns out of her experience, sometimes people try to shoot her concerns down rather than addressing them, and some of them are very serious.

I believe that this bill is actually a step in the right direction. I think that paramedic practitioners are a fantastic idea, similar to nurse practitioners. They fill an absolutely vital spot in our healthcare needs in this state. What they will be able to do will expand the scope of their practices – as is being done in other places in the world – which will allow them to assess, treat and administer medications where they have not been able to do that before. I think that is a fantastic idea, because often ambulances do attend non-life-threatening crises that people are having. Rather than having a healthcare crisis where more and more ambulances are ramping and taking up vital resources, those people will be able to assess, diagnose and treat those patients without needing them to come to hospital. I think that is a fantastic idea. It is one step forward.

I want to talk also about the two steps back that this government is taking by closing CERTs across regional areas. For those of you that do not know, CERT stands for community emergency response teams, which play an incredible role in rural and regional areas. It has been a huge concern of mine that, for instance, the CERT team in Lang Lang and the CERT house have been shut down despite the community really needing them. Ms Terpstra also said those in rural and regional areas should have access to health care when they need it. I absolutely agree. But the fact is they do not, and with 30 graduates coming out and the closure of CERTs they will not, unfortunately. There are some serious issues that need to be addressed here.

Victorians have completely lost confidence in the Victorian healthcare system. They do not have access to health care when they need it. You will remember that last sitting week last year I spoke about a tragic situation that occurred in Gippsland where a lovely young girl in her 30s was in severe pain. She got told by the person taking the call that it was period pain and they would not send an ambulance. After three or four calls to the ambulance they finally, days later, sent a non-emergency ambulance from Morwell. By the time they got there and assessed that this girl was in a critical condition, they then had to get an emergency MICA ambulance and another ambulance from the Sale Hospital that they had refused to send days earlier. This girl then had to undergo multiple surgeries. She had to be revived twice and is now left with lasting impacts. This is a serious issue, and we need to do better. It is absolutely devastating.

I have also told stories about constituents in my electorate that, while they were members of the more than 60,000 people that are waiting for elective surgery, got sicker and sicker and sicker and had other complications develop, and I told you about the one constituent of mine who unfortunately died while waiting for that surgery. So we have some serious issues. I think it is very good that we are taking bold steps to move forward and lead the way in the nation – not in the world, as plenty of other places are doing it in the world, but in the nation certainly – to be the first that is training ambulance practitioners. I think it is fantastic. I think nurse practitioners also play a fantastic role, particularly in rural and regional areas, where we just do not have the personnel to service the population.

The real concerns about the state’s health policy mismanagement have flowed through to paramedics in this state, and this will persist for another two years while these 30 people are being trained. We do not know if the 30 people are going to finish the course. That is another issue, because attrition rates are not great in this state and there are many reasons for that – the cost-of-living crisis, different pressures – so it is something we have to look at.

Often we have seen in this state that, rather than investing in health care in rural and regional areas like mine – and by the way, the further you are away from metropolitan centres if you get cancer, the more likely you are to die within five years. That is fact and it is devastating. We do need to do something to bring equality into our healthcare system across the regions, because my area does not have as good outcomes – they are not great in Melbourne either – as city areas, and the statistics are quite devastating. So there are some serious systemic issues such as ambulance ramping, workforce shortages and underfunding that are compounded by the lasting effects of the pandemic and the neglect in regional areas. Without targeted investment and reforms, the strain on the regional health system is unlikely to ease.

But I do want to just spend some of my time talking about the closure of the community emergency response teams and the impacts that that will have, because let me tell you, even if every one of these 30 postgraduate students complete their course, it is not going to fill the void that this government is leaving by pulling out those resources in communities. The CERT closure is part of a broader pattern of neglect towards regional health care in Victoria. Ambulance response times have deteriorated. They have got a lot worse – I will go through the statistics of those if I have time later on. Hospitals are underfunded. Big Build projects in Melbourne receive priority while regional health care suffers. This has been an ongoing pattern.

The closure of CERTs will make ambulance and emergency response times even worse in Eastern Victoria, leaving rural and regional residents without crucial early medical intervention. The CERT in Lang Lang will close after 20 years of service in another major blow to regional emergency response services in our area. Another thing Ms Terpstra said was that healthcare practitioners should be able to rest, recoup and recover. This is another thing: the Labor government took away the funding for the CERT house in Lang Lang, which allowed healthcare practitioners to come and stay there on shifts. They are now closing that, so these people will have nowhere to rest and recover. It is really not good enough.

CERTS played a crucial role in bridging the gap between emergency calls and ambulance arrivals in rural and regional areas. They are actually critical. Ambulance Victoria says that the closure was due to failing volunteerism, but members of my community disagree. They say that AV mismanagement is ignoring the processing of applications and has done so for at least 12 months. Sometimes there is a real big disconnect between the narrative and the reality, because I have spoken to at least four people that wanted to volunteer in the area of Lang Lang and I have spoken to people that have volunteered there for over 20 years, and they are now getting sidelined and their skills are being lost. It is really tragic for people in rural and regional areas. Former CERT workers have spoken out, stating that their knowledge and skills are now going to go to waste.

Why is this important? CERT volunteers provide volunteer-based – so no cost, apart from the training, to the government – teams training to provide life-saving support and first aid and stabilise patients in remote areas before ambulances can arrive. This is really crucial when you look at a region like mine, which is 44,000 square kilometres and takes up roughly 20 per cent of the state in terms of landmass. We do not have quick access to health care here like other people do or have the ability to have. They were crucial during the onset of COVID, and CERT responders actually won awards for their incredible efforts. They were often the first on the scene for heart attacks, strokes and trauma incidents, especially in regional and rural areas, where just because of the area that people have to travel, they have long wait times. They would never transport patients, but they played a crucial role in assisting paramedics and reducing response delays.

The justification from the government is that CERTs were not required under a modernised emergency response team. The reality is that the removal of CERTs has left rural and regional towns without immediate care, as the promised new emergency response model has not been adequately implemented. The closure of CERTs is absolutely devastating in Eastern Victoria Region. Many small towns relied on them, and they have no emergency response until an ambulance can arrive. I think it is absolutely wonderful that the ambulances that will arrive will possibly be more highly qualified and more able to assess, diagnose and treat, but the wait times are getting longer and longer. This is a particularly critical issue in my area, where ambulance wait times exceed 30 or 40 minutes due to ramping and staff shortages. Ambulance Victoria claims that CERTs would be replaced by more paramedics and more new responder units. The reality is there has been no clear evidence that their replacements will materialise in Eastern Victoria Region.

I just want as well to pick up on another thing that Ms Terpstra said. She really gave the Liberals a bit of a hammering about our apparent relationship with emergency services teams. I just want to highlight that while you can sometimes pick out a bit of a flaw, do not ignore your own, that emergency services in this state have to use their vehicles as a vehicle of protest by putting signs on the back of their –

A member interjected.

Renee HEATH: For years.

Members interjecting.

Renee HEATH: Well, I think at some stage you just have to address the issues that are in front of you, because we have had 10 years of Labor governments and we have got people using their emergency services vehicles as placards. I think it is quite extraordinary that over the last 25 years there has been a Labor government – apart from four – in this state, yet apparently everything is the fault of the Liberals. It is a government that has refused to take responsibility. You have driven us into so much debt that we have more debt than New South Wales, Queensland and Tasmania combined. We are paying a million dollars per hour in interest alone, so you do not even have the money to solve the problems that you have created. All you do is continue to point the finger. It is actually pretty transparent and disgraceful.

I just want to talk about one other thing while I have about 2 minutes left, which is the shortages in staff. There has been quite a focus on new facilities and things like that, which by the way have not been delivered. They are well and good, promises like that, but if we do not have the staff to man those buildings, there will not be outcomes. It is just going to result in more government waste. There are currently over 60,000 people on the elective surgery waitlist, and one key reason is a chronic lack of hospital staff. Regional hospitals such as Latrobe Regional Hospital in Traralgon and Bairnsdale regional hospital have been grappling with these staff shortages for years. The problems are just being exacerbated by the mismanagement and the increased delays. Patients in smaller towns like Sale and Maffra are often transferred to larger facilities like Traralgon or Melbourne for specialised care, adding strain on ambulance services because of the interhospital transfers.

I have got 30 seconds left, so I just want to say that I do believe that this is a step forward. I do believe that we should be upskilling and training our staff better. We should help them do better in their jobs and receive the training that they need. I welcome the change, but I wish it was not met by the two-steps backwards of the closure of CERTs.

David ETTERSHANK (Western Metropolitan) (11:01): I rise to make a brief contribution to the Drugs, Poisons and Controlled Substances Amendment (Paramedic Practitioners) Bill 2024, and let me open by just saying that Legalise Cannabis Victoria is delighted to support this bill. I have nothing but the utmost respect and admiration for our paramedics. I have been involved in a few medical emergencies in recent years – a product of the passage of time – and I recall the profound sense of relief that I experienced when I saw those paramedics walking up the path to the front door, knowing in my heart that I was in the hands of professional, competent and compassionate health professionals who would take on board the challenges that were confronting us. I do not think we really understand or appreciate just how important paramedics are until we need them. I am not hoping that people do need them, but it is fabulous to know that they are there.

I think we also mostly think of paramedics showing up in ambulances and responding to emergency calls and basically then doing immediate treatments and transferring people to hospitals. The paramedic practitioner is a new and wonderfully extended role. Paramedic practitioners will be qualified to provide greater levels of care in settings outside of emergency patient transportation, including but not limited to GP surgeries, community health centres, public and private hospitals, aged care facilities and alcohol and other drugs facilities. They will operate in much the same way as nurse practitioners have for some years now in the community, and clearly that exercise with the nurse practitioners has been a terrific success. Paramedic practitioners will provide primary care services like health promotion, disease prevention, acute care and assistance with management of chronic health conditions. They can follow up with patients, enabling that continuity of care, and can also refer patients when necessary.

Critically, paramedic practitioners will be able to handle and administer scheduled medicines, allowing them to prescribe and supply medications on the spot. And this is the substance of the bill before us, if you will pardon the pun. The bill before us amends the Drugs, Poisons and Controlled Substances Act 1981 to define a paramedic practitioner, and that is a registered paramedic who has completed the relevant postgraduate qualifications and meets the prescribed experience requirements, and to authorise them to practise autonomously. It gives paramedic practitioners the authority to obtain, possess, use, supply, sell, administer and/or prescribe schedule 2,3,4 or 8 medicines. It allows them to access and disclose information on the SafeScript database and inserts a requirement for practitioners to check the database before supplying or prescribing a monitored poison.

There are currently, as I understand it, 29 paramedics undertaking the paramedic practitioners masters degree, and once they graduate they will be deployed primarily to regional areas. The government, I am pleased to see, has also committed to funding scholarships for a further 100 paramedics over the next four years, and I have no doubt that these numbers will grow. Paramedics have limited career opportunities currently. We lose all too many paramedics through burnout because it is a tough gig, and unfortunately they end up leaving the sector.

The CEO of the Australasian College of Paramedicine John Bruning has warmly welcomed the professional recognition and expanded career opportunities for paramedics, stating that the

… creation of a Paramedic Practitioner role in Victoria is a transformative step for the profession and for the healthcare system as a whole …

This is something that has been advocated for and by the ambulance union for some time. The member for Melton in the other place, Mr Steve McGhie, who is also a former secretary of the ambulance union, mentioned that he had approached the then health minister about the idea back in 2016. It has the support of the ambulance union and the paramedics association, so it is great that it is finally being rolled out.

Victoria is the first state in Australia to introduce paramedic practitioners, but they have been operating in the UK since the early 2000s and have, over time, accounted for an approximate 50 per cent reduction in patients unnecessarily being transported to hospital. In that context I do not think anyone in this place could be other than supportive of this initiative. We commend the government for taking this step to reduce the number of people that unnecessarily end up in our emergency departments. We believe it will go some way to relieving the pressure on our overstrained health system and hopefully may also help to retain more of our dedicated and hardworking paramedics.

Jeff BOURMAN (Eastern Victoria) (11:07): I am just going to make a quick contribution on this. I rise in support of this. Over the years I have had both professional and personal interest in ambulance paramedics, and I have found them to be almost faultless. When I say ‘almost’, one of the problems I have had is their inability to sometimes give fairly straightforward drugs that would fix problems at the time. They had to take patients to the hospital – ramping – and then we have the disaster where we are at the moment.

This is a great step forward. Our paramedics on the whole are probably better trained – and they are certainly very experienced – than most in the world. Our level of expectation of our paramedics is much higher, and they deliver and they deliver well. This is going to take it to another degree. I obviously believe wholeheartedly that they will just step into this. It is something that will make their life easier, make our lives easier and help the patients, and it will start to address things like the ramping problem. I do not believe anyone is against this, nor should they be. I commend this bill to the house.

Ryan BATCHELOR (Southern Metropolitan) (11:08): I am pleased to rise to speak on the Drugs, Poisons and Controlled Substances Amendment (Paramedic Practitioners) Bill 2024, as speakers have reflected, an incredibly significant piece of legislation that will deliver on an election commitment by the Labor government to better support our paramedics and to create and enshrine in law this role of paramedic practitioner.

The amendments that will be proposed to the substantive act by this bill will help establish and implement the new paramedic practitioner role here in Victoria and expand the scope of practice not recognised in the existing legislation by authorising paramedic practitioners to autonomously obtain, possess, use, supply, administer and prescribe scheduled medicines under instruction. Those authorised paramedic practitioners will be those who are registered and have completed prescribed postgraduate qualifications that ensure that they have got the experience and expertise required.

The amendments in the bill will also allow paramedic practitioners to access, use and disclose information on the monitored poisons database, otherwise known as SafeScript, and to require that these paramedic practitioners check SafeScript before supplying or prescribing a monitored poison, similar to the obligations that exist on registered medical practitioners and nurse practitioners. It is a sensible expansion of these revisions to this new role that is being developed that will – and I will come to this in a minute – assist our broader healthcare system by ensuring that these health supports can be provided in settings other than emergency departments. The bill will also ensure that legislative amendments are in effect to provide authorisation in time for the first deployment of paramedic practitioner graduates in 2026.

The legislation before us today is significant not only for the substance of what it is delivering but also because it puts Victoria at an Australian-first, nation-leading position yet again in the delivery of innovation in our healthcare system, in the delivery of better outcomes for those who from time to time do fall unwell in the community, and it is a hallmark of the way that the Labor government has approached the question of health policy, that we are always seeking to improve, that we are always seeking to make sure the system is better and is responding to contemporary demands that are facing the Victorian community, and that it is always able to evolve and adapt and support the development of our healthcare workforce.

One of the critical things that we always need to remember in supporting our healthcare workforce is that we have got to provide opportunities for these professions to grow, for these professions to undertake and improve their set of professional qualifications so that there are both career trajectories but also that the structure – the employment structure, the qualification structure – recognises and values the work that they do, because as many in this debate have already pointed out, the skills that paramedics bring when they arrive at the scene of an emergency situation are so valuable and valued by the patients that they serve. The new role of paramedic practitioner that the Labor government committed to developing, which will be enshrined in this legislation, and that we are right now training for in our higher education institutions so that they are ready to be deployed in 2026, will mean an expansion of the skills and a recognition of the expertise that exists in our paramedic workforce.

The reason we are doing this is for the workforce, of course, to provide those career pathways, to provide the recognition of the skills that they have. It will also help take pressure off our emergency departments, because we know that public hospitals and our hospital emergency departments are feeling the strain of increased demand, an increase in demand that is undeniable, and I have spoken in the past in this chamber about the challenges that our healthcare system is facing through increased demand. What this measure is designed to do is provide more capacity for healthcare professionals, our paramedics, to deliver more healthcare services out in the community and do the things that need to be done when they get there without having to transport someone into an emergency department so that certain medications can be prescribed and dispensed. It will take pressure off those emergency departments. It will allow the emergency physicians in those emergency departments and the nurses who support those patients to be focused on higher level emergencies, and to be focused on the higher acuity patients that are presenting.

This bill is about expanding how our healthcare system can support Victorians, and to support that, we as a Labor government invested $20.1 million in the 2023–24 budget. We have established Australia’s first ever paramedic practitioner masters degree at Monash University. Following the 30 graduates who began in 2024, we have a second cohort about to commence and we are providing scholarships over four years to help support those undertaking that course. It is Victoria leading the nation, a first-in-the-nation set of reforms, but it is based on experience in some other jurisdictions, in the UK and Canada and the Netherlands, where this sort of an approach has proved particularly effective. So we are learning from overseas and we are innovating and nation leading here at home.

It obviously complements some of the other changes that we have been making across the healthcare system: the rollout and support of nurse practitioners and the support we are giving to general practitioners. I was with the Minister for Health and my colleague Mr Berger recently talking to some new general practitioners in the Southern Metropolitan Region about the support that the state government has provided them to continue their training and practice. That is one example. This is another example here today of how the Labor government is supporting our healthcare workforce to get the skills and training they need to serve the healthcare needs of the Victorian community.

We know that our paramedicine workforce plays an exceptionally critical role in our healthcare system providing prehospital care, first on scene care, first responder care and emergency medical response to over 6.7 million Victorians. Paramedics regularly assist with the transfer of people with serious conditions to hospitals, and with the advanced clinical training for the new masters program and postgraduate qualification, these new paramedic practitioners will be better able to assess, diagnose and treat patients in the field, assist with the making of clinical decisions and assist the emergency departments and their workforce to be able to more easily focus on higher acuity cases and presentations in EDs.

It is just another example of how the Labor government has been supporting our paramedic workforce and our hardworking paramedics and ambulance staff. Since being elected we have invested more than $2 billion into our ambulance services. Our on-road staff in Victoria have grown by more than 50 per cent. More than 2200 more paramedics are on our roads than when the Liberals were last in office. We know that there is increasing demand; that is why Labor has been investing so much in our paramedic workforce. More than 1300 paramedics have been recruited in the last three years.

The opposition in their contributions like to talk down our paramedic supports, like to talk down our healthcare system and try and suggest that there has not been significant record investment from the Labor government. I thought it would be perhaps a bit instructive then to look at some facts, because I know the opposition does not like it when facts get injected into debate. It undermines their narrative because it exposes the truth. When you go and look at the facts and you look at what an extended period of a Labor government investing in our paramedic and ambulance services means, you can see the value. You can see how Labor has made a difference to the ambulance services here in Victoria by looking back at what they look like when the Liberals last had the opportunity when they were in government to make decisions about what mattered to them. Because that is what budgets are about. They are about making investment decisions about what matters to you, and what this Labor government have demonstrated in the budgets that we have handed down since being elected in 2014 is that supporting our healthcare system, supporting our healthcare workforce and supporting that system and workforce to deliver better health outcomes for Victorians who need support, who are unwell, who are sick and who are injured and providing them with that support is what this government has done.

We have in Victoria more qualified ambulance officers than any other state – more qualified ambulance officers than any other state right here in Victoria. Why is that? That is because of the investments that this Labor government has made. We have got more qualified ambulance officers than there are in New South Wales, despite New South Wales having a higher population than Victoria. Despite New South Wales having a higher population than Victoria, there are more ambulance officers here in Victoria according to the latest data from the Productivity Commission in the report on government services. But it was not always like that, because if you go back there is a handy table in the report on government services, the 2022–23 report that was released about a year ago. The latest set of data is being released tonight at 10:30 for those who are willing to stay up late to get the update. But if you go and have a look at what that report tells you about the situation that existed 10 years ago, you can see the priorities that have existed, because whilst Victoria today has the highest number of ambulances officers in the nation, more than New South Wales despite having a smaller population, in 2013–14 when the Liberals were last in power, New South Wales had more ambulance officers than we did.

When we came to government we were behind New South Wales in the number of ambos on our streets and today we are ahead. I think that goes to show the priority that Labor has placed on paramedics, on ambulance officers and on supporting our healthcare system since the time we were elected to government in 2014. It reflects the sustained commitment that this Labor government has had to supporting ambulance officers, to supporting paramedics and to supporting our healthcare workforce, despite some particularly challenging times. I will not go into that. But since 2013–14 Victoria moved from second to first in terms of the number of ambulance officers employed by the system. Also, I should say in terms of the amount of direct government funding to ambulance services, it is very clear that we have made significantly more investment than probably the other comparable jurisdictions in the nation.

We know there are challenges to our healthcare system. We know that both the volume and the complexity of the demands that are being placed on our healthcare workforce are growing as our population grows, as the sorts of presentations that are being made to healthcare workers and the sorts of issues that our paramedics and ambulance officers are responding to on a daily basis grow. We know that that complexity is growing and we know that the volume of demand is growing, and that is why we are continuing to invest. We are continuing to support our ambulance workforce.

My colleague Ms Terpstra talked about the quite significant pay deal that was reached between the Victorian government and the ambulance workforce and the ambulance unions late last year. That locked in the kind of support that is necessary to support that workforce going forward and received overwhelming support. Their enterprise agreement received overwhelming support from the workers in the ambulance system – paramedics, ambulance workers and others – when it was put to a vote recently. I think it is a demonstration that this government stands up for our paramedics, stands up for our healthcare workforce and stands up for our ambulance workforce. It is not just something we talk about; it is something we deliver, and it is a track record of delivery since we were elected in 2014 that speaks for itself – more ambulance officers than any other state compared to a situation that was different 10 years ago and continued investment in the professional development of the ambulance workforce.

This bill today enshrines a brand new, nation-leading paramedic practitioner qualification that is going to better support Victorians who need an ambulance, who call out for support out in the community, and it will have broader benefits for the healthcare and hospital systems. I am very proud to stand and support it here today.

Gaelle BROAD (Northern Victoria) (11:23): I am pleased to be able to rise to speak in this chamber today about the Drugs, Poisons and Controlled Substances Amendment (Paramedic Practitioners) Bill 2024. This bill does seek to open the door to further training for our paramedics so that they can be out and about assessing, diagnosing and treating people to reduce the number of cases that are transferred to emergency departments and to try and relieve some of that pressure on a very burdened health system.

I do want to correct the record. On this side of the house, we certainly do not talk down the role of paramedics. In regional Victoria, I can tell you, they are our heroes; I know from personal experience. A member of my family had their life saved last year by a very prompt response by a MICA paramedic. That saved their life, and I will be forever grateful for that. So we do not oppose this bill. This is a step in the right direction. But we do need to be very real about the challenges that are faced in our community, particularly in regional areas.

I know in Bendigo, and I have spoken about it in this chamber before, I have seen up to 10, 11 ambulances ramped outside Bendigo Health. We know the same has been happening in Wodonga. It has also been happening in Shepparton, and it has been raised by my colleagues in the other chamber. This is a sign of a very sick health system, because we need to ensure that ambulances can transfer patients to the hospital to get the care that they need so that they can be out on the road again. But there are challenges. We know Bendigo Health has had a code yellow, and the Bendigo Advertiser has reported extensively about the stress and the pressure that is on the staff there at the hospital. I have heard stories from people that have been in wheelchairs in corridors because no bed has been made available to them, not just for a few hours; we are talking 24 hours. I have heard of other people that have taken family members to Heathcote and been unable to access a doctor there, having the nursing staff connect via telehealth to get assistance.

We know in Bendigo that the funding for the clinical support nurse educator roles has been cut. They are the people that help train the new nursing staff that are coming through. I have spoken with nurses who are concerned because they already have a very full workload, and now they are being asked to take on that additional training, which is quite a unique skill. We need to ensure that we have the nursing staff coming through, because there are quite a number of nurses that have left the system and who continue to leave the system because they have been under pressure. We particularly saw that through the COVID period in the pandemic. We know in regional areas there is a lack of GPs. We want to see more training conducted in regional areas to enable them to live there, to bring their families and stay and support our health system and the demands that are there.

Obviously the government has been aware of some of these issues. In 2023 they established an independent expert advisory committee. It was established to look into and consider how to improve access and equity of our health services for all Victorians. But I would question how independent it was, because Bob Cameron, who is a former Labor member for Bendigo West, a former Labor minister, led that review. He was a former chair of Bendigo Health, and surprise, surprise, Bendigo Health is now the lead in one of these networks. Bendigo Health is certainly expanding. We have got Boort covered in Boort District Health, Cohuna District Hospital, Echuca Regional Health, Heathcote Health Service, Inglewood and Districts Health services, Kerrang District Health, Mallee Track Health and Community Service, Mildura Base Public Hospital – which I will add is about 400 kilometres away from Bendigo – Robinvale District Health Services, Rochester and Elmore District Health Service and Swan Hill District Health. These are huge networks. This got announced in January. It is meant to be implemented in July, and it raises lots of questions. What does this mean? Who is going to manage it? How will it be funded? What extra work is this going to impose on our already burdened hospital staff? It is certainly another layer of bureaucracy, and there is no sign of how that layout is going to be funded through Hospitals Victoria, a new agency in the Department of Health. I guess this government does like to make things bigger – they like big debt and are big on control – but they are certainly not always better.

I am interested that this bill does look at expanding the role of paramedics and the services they provide, which is very important, but I would say there is also work that we can do to further alleviate the pressure that our health system faces by looking at pharmacies and the number of services that are provided by pharmacies in Victoria. We know that a pilot program took place to expand the services they offer. and there were five new services covered by that. But other states like Queensland have been a real leader in this space, and there are an additional 20 or so services that are provided in other states, which would be good to see happen in Victoria. The things that other states have made moves to provide are things like pharmacists assisting with the treatment of moderate acne; weight management for obesity; asthma, which is very common; allergies; ENT, like ear infections; type 2 diabetes; acute nausea and vomiting; and even for smoking cessation. There is a lot of work that the pharmacists are keen to see added, I guess, to their list just to really reduce that pressure of having to go to your GP or present to emergency. Pharmacists do an incredible job in our communities. I know that 760 pharmacies were involved in that pilot program. We had a round table at my office just last week with David Littleproud, who is the Nationals’ federal leader.

A member interjected.

Gaelle BROAD: Yes, he came. Andrew Lethlean was there, who is the federal candidate for Bendigo at the next election, and we also had Darren Chester, who is all about regional development. It was great to have representatives there from Latrobe, from pharmacies in Wedderburn, from Kerang and from throughout Bendigo talking about the important work that they do and how willing they are to provide that additional support that the community needs to reduce that pressure. I know my colleague Georgie Crozier, the Shadow Minister for Health, also talked specifically about diabetes as a former diabetes educator. There are quite a number of people that end up in hospital that could be prevented from doing so, and it is about identifying those areas. As I mentioned, diabetes is one of those extra services that pharmacies can provide assistance with in other states, so I hope that Victoria heads in that direction.

We certainly need to reduce ambulance ramping. We need to reduce the number of people that are attending our emergency departments, and we need to get ambulances out of hospital car parks and back onto the road, providing that emergency support. I have heard from people in Bendigo – this is very close to a major hospital – that have been told, ‘No ambulance is available. You need to get a taxi.’ I have had a patient that actually had a fire service respond because no ambulances were available. I heard from another family member in Donald, and I have mentioned this previously, who unfortunately waited over 2 hours for an ambulance – they were 200 metres from the hospital in Donald. Unfortunately the father passed away the next day. We do not want to see this kind of response happen in future. We certainly, as I mentioned, do not oppose this bill. It is a step in the right direction.

David LIMBRICK (South-Eastern Metropolitan) (11:32): I am very pleased to speak on the Drugs, Poisons and Controlled Substances Amendment (Paramedic Practitioners) Bill 2024. I will say at the outset that the Libertarian Party will be strongly supporting this bill. What this bill does is set up a new class of paramedic, called a paramedic practitioner, and give them certain abilities to possess, sell and supply certain substances, which would mean drugs in most cases. One of the things that I think is important to acknowledge is the work that is done by paramedics in this state. It is a very difficult job. They work very, very long hours. They are exposed to extremely stressful situations and traumatic situations, and I commend the work that they do.

This bill or this this action will effectively create a new career pathway for paramedics, allowing them to upskill and obtain new abilities that they can work with to help Victorians. One of the things that I would like to focus on in this bill is around the issue of pharmacotherapy. I have been a strong supporter of expanding pharmacotherapy options for heroin addicts in Victoria, in particular. In my own area of Frankston, as I am sure the minister would be very well aware of – and I have worked with the minister on this – we had a very big problem with only a single doctor effectively prescribing pharmacotherapy to patients in Frankston. Eventually they were going to shut down, and it caused huge problems. I am glad to report that Peninsula Health has taken over that function, and my understanding is that it has now stabilised, which is fantastic news.

I would also like to commend the government on their expansion of pharmacotherapy options in Victoria. It has long been my view that a big contributor to people getting off heroin, getting out of the hands of organised crime and stopping committing petty crime to feed their addiction is to get them on pharmacotherapy, but we had this situation where only a very small number of GPs could prescribe these medicines, and it was very, very difficult for people to obtain them. Many people ended up just going back onto heroin and back into the hands of organised crime, and this is a problem. I know that the government is expanding this, but one of the things that this bill will do once the paramedic practitioners step into action is allow them to be able to prescribe these substances. This will be a small but very significant increase in availability and options for distribution of these medicines to help stop people going back on heroin and to help people get off heroin and stabilise their lives and eventually, hopefully, get clean. This will hopefully also stop or at least somewhat reduce the number of people requiring pharmacotherapy who present to emergency departments, because the paramedic practitioner will be able to prescribe these medicines. Hopefully, that will increase the efficiency of emergency departments also, so that they can focus on more acute cases. As we all know, for some time emergency departments have been under a very heavy load, and anything that we can do to reduce that load is a good thing. This is one thing that will help, I believe.

I know that the government has committed to a trial of a new pharmacotherapy option, hydromorphone. It is a limited rollout at the moment, but it is my hope in the future that this will be expanded, because the more options that we have to get people off heroin and into the health system, the better for Victoria. It is good for the people who have these problems with drugs. It is good for undermining organised crime, which we all know we have a huge problem with in this state. It is also good for preventing petty crime that people commit to feed their addiction, because they no longer have to feed their addiction through crime, they can merely get a prescription from a doctor or from a paramedic practitioner, which is a great thing, I think. We need to do as much as we can to help these people get out of the hands of organised crime. It is too much of a problem in this state. Organised crime has infiltrated so many different areas, and we need to do everything we can to undermine it.

I am often very critical of the government on many, many things, but in this case I am not critical of the government. I think that this is an excellent move that the government is making, and this will be strongly supported by the Libertarian Party.

John BERGER (Southern Metropolitan) (11:37): Today I rise to contribute to the Drugs, Poisons and Controlled Substances Amendment (Paramedic Practitioners) Bill 2024. This bill provides amendments the Drugs, Poisons and Controlled Substances Act 1981. These amendments establish the legal framework for Victoria to champion the paramedic practitioner role within the national workforce framework. The Allan Labor government responds to the growing and increasingly complex demands on both urgent care services and health services in Victoria in this bill. These services are responsible for the medical care of 6.7 million Victorians. This year alone the Victorian ambulance service received 2790 emergency calls per day and provided emergency medical care to almost 400,000 Victorians who experienced code 1 lights-and-sirens ambulance emergency events. The paramedics that arrive at these emergencies are tirelessly dedicated, compassionate and operating under immense pressure. I commend them for the hard work that they do, often under less than ideal circumstances, and for their services to Victorians.

I thank my friend in the other place Minister Thomas, our Minister for Ambulance Services, Minister for Health and former Minister for Health Infrastructure, for her work on this bill as well. It is a great piece of legislation that tackles many of the issues affecting our urgent care services and in turn our paramedics that operate within their frameworks. Our support for paramedics and ambulance services is essential. This legislation is one facet of ensuring that they have the necessary resources and training to provide timely, reliable and effective emergency care to our communities. The Allan Labor government will always stand with the frontline healthcare workers, and I am proud to support legislation, like this bill, that does just that. Through these reforms we support paramedics, and we will protect Victorians.

The provisions of this bill and its proposed amendments are as follows: firstly, they establish the paramedic practitioners as a class of registered paramedics; secondly, they authorise this new class of paramedic practitioners to obtain and use certain substances; thirdly, they expand access to a monitored poisons database to paramedic practitioners. The paramedic practitioners initiative works alongside other initiatives of the Allan Labor government to improve the efficiency and capability of our health system. These include our Victorian Virtual Emergency Department, which is a video telehealth medical consultation service that is accessible to Victorians 24 hours a day, seven days a week. Like the introduction of the paramedic practitioners to our frontline emergency health system, the VVED is the first of its kind in Australia.

The VVED has seen over 400,000 Victorians since its pilot in 2020 and has been available statewide since 2022. It sees over a thousand Victorians daily. It provides clinical assessments, medical advice, treatment and local referrals to Victorians experiencing non-life-threatening emergencies. These services are provided to patients through a range of qualified health professionals, such as GPs, specialist nurses and emergency physicians. Through its services 86 per cent of its patients have been able to avoid unnecessary trips to emergency departments. This has reduced overcrowding in these departments and improved quality of care for patients.

The first provision of the bill will establish paramedic practitioners as a new class of registered paramedics, as I said earlier. These paramedic practitioners will have a greater ability to treat and medicate their patients than existing paramedics. Under this legislation the term ‘paramedic practitioner’ will refer to a registered paramedic that has completed a prescribed postgraduate qualification and satisfies prescribed experiences required. At present the prescribed postgraduate qualification is the master of paramedic practitioner and is available as a part-time, three-year course at Monash University for registered paramedics with five or more years experience. Under this bill the authority that currently governs nurse practitioners will also govern the new class of paramedic practitioners who have completed their postgraduate qualification.

The provisions of this bill, secondly, will authorise paramedic practitioners to obtain, possess, use and supply certain medications. This new class of paramedic practitioners will all be able to autonomously assess and diagnose patients and make clinical decisions. Effectively this enables paramedic practitioners to treat individuals requiring emergency medical attention in the field, at the site they were called to, at their discretion.

They will have multiple roles in improving the function and efficiency of our emergency healthcare services. These can be broken into four key parts. Firstly, as I said before, their ability to treat individuals in the field will prevent transfers of these individuals to hospitals where it is unnecessary. Secondly, the prevention of these unnecessary transfers will free up space in our emergency departments. Through this, the presence of the paramedic practitioners on our front line will reduce pressures on emergency departments, public hospitals and general practitioner patient loads. The bill focuses on emergency medical care, these situations where there is a time-critical factor. Lastly, the introduction of the paramedic practitioner class will improve the efficiency of our emergency healthcare system. Victorians who experience a medical emergency will receive a quicker response from both ambulance services and emergency staff. This is because a greater proportion of patients utilising ambulance services will be able to be fully treated at the scene and will not have to wait for their admittance to inpatient care at an emergency department for their treatment to be completed. Additionally, the emergency departments will not be overwhelmed by patients that have been transferred unnecessarily. This will reduce their overall patient load and enable patient care to be provided to the individuals who need it most.

The final provision of the bill will expand access to the monitored poisons database SafeScript to paramedic practitioners. This is the database that contains records of patients’ prescriptions and their supply history of high-risk medicines. Paramedic practitioners will be able to access, use and disclose information pertaining to the patients on SafeScript and will be required to check this database before prescribing or supplying a monitored poison. These are the same regulatory standards that medical practitioners and nurse practitioners abide by.

Experienced paramedics will also be provided with a new avenue for career progression and greater career opportunities through this bill. Providing greater scope for these things is a fantastic measure both to encourage young Australians to join the paramedic workforce and to retain its existing members. The bill acts to extend and reach out our health system as well as increase accessibility and timelines of health care, particularly in rural and regional areas. That is what this bill legislates and what our paramedic practitioners will do. I would like to take a moment to expand on the credential paramedic practitioners will be able to attain as part of this role. Firstly, I reiterate what I briefly outlined earlier: the term ‘paramedic practitioner’ will refer to the class of registered paramedics that has completed the master of paramedic practitioner program. The program is being delivered by Monash University at their Peninsula campus. It requires students to have at least five years of experience as a registered paramedic and is available to domestic students and holders of the Australian temporary visa that have full study entitlements. It is a three-year part-time course. This will enable its students to continue working as paramedics while they study. The master of paramedic practitioner program was developed by Monash in consultation with multiple relevant industry representatives; these include Ambulance Victoria, Safer Care Victoria, paramedics, clinicians and unions.

Under this legislation Victoria is set to become the first state in Australia to introduce the role of a paramedic practitioner. In 2023–24 the Victorian state budget invested $20 million into funding this initiative. A significant proportion of this money has been allocated to supporting scholarships for paramedics completing the program. The first cohort that will complete this course will begin their studies in February of this year and will include 30 students. The second cohort will begin their studies in February 2025. Upon their completion of the master’s program paramedic practitioners will be qualified to assess, diagnose and treat a greater range of medical issues locally. Part of this will be handling and administering scheduled medicines and prescribing and supplying medicines at the scene.

Paramedic practitioners will play a key role in delivering integrated, multidisciplinary and modern health care tailored to the needs of the Victorian community. The first graduates from the program will be deployed in regional areas to accommodate this. This is where our health system is most poorly equipped and most overwhelmed. I am particularly proud of this initiative, and I think it is a fantastic program and is a demonstration of the Allan Labor government’s commitment not only to our health sector but to our education sector. Through this bill we will not only deliver on reforms for our emergency health system but expand our tertiary education opportunities as well. We will keep Victoria being the Education State, and I say this – and I just want to touch on this briefly – because we know that we cannot train the required number of ambos without an education sector that has the capacity to do so.

The Allan Labor government has also achieved record levels of investment in education. From January 2025, a month before the second cohort of paramedic practitioners commence their course, 5200 new fee-free TAFE places will be made available to Victorians; this will include 1300 pre-apprenticeship places. They will target and address critical skills shortages. Nationwide, 508,000 have enrolled in fee-free TAFE since its launch. Our investment in education is not limited to tertiary education. We are also opening 19 new schools across the state in 2026; these will include 13 primary schools, three secondary schools, two specialist schools and one year 9 school. Over the past 10 years the Victorian Labor government has invested $16.9 billion in building new schools and providing school upgrades; these include $1.8 billion in investment in the 2024–25 budget. The investment has funded 2200 school upgrades and supported 26,000 jobs in construction and associated industries. Our other investments in education include scholarships, financial incentives for hard-to-fill roles and paid placements for individuals training to be teachers. These initiatives have grown the government schools teaching workforce by 1700 teachers in the past year alone and have totalled $139 million. Our initiatives and investments mean that our students, Victorian students, are engaged in education at the highest rates in the country.

I am the husband of a nurse, the son of a nurse, the brother of a nurse and the father of a nurse. I am exposed to this every day; in fact we all are. Everyone has been cared for by a healthcare practitioner from the moment they are born, and despite what those opposite might want to do to talk down our paramedics, we on this side of the chamber will not. According to the national report on government services this state has the most registered paramedics in the country, more than any other jurisdiction, and the same report said our response time is better than in New South Wales, Queensland, South Australia and Tasmania. When those opposite were in government our ambulance response times were the worst on the mainland, and we know that there is always more work to do, and we are not letting this go by. Within two years of coming into government we ended the war on paramedics, and as result response times improved. It meant that 80 per cent of code 1 cases were responded to in 15 minutes. We know that Labor governments are governments trusted by the people to stand up for the healthcare system – for Medicare, which celebrated its 41st birthday over the weekend federally and in Victoria, where we have continued to innovate. I was proud the other week to have the Minister for Health in the other place, Minister Thomas, visit my community of Kew to talk to the general practitioners about our incentives and work in providing a kickstart for careers as GPs. There is more than that to do.

We know that growing the population of paramedics is part of our health network, and we are dealing with a record demand – the current number is 30 per cent higher than prepandemic levels – but despite this, most recent data shows that our ambos are arriving 16 seconds faster than the previous quarter. Does that mean that the work is done? No. There is always more to do and that is what we are doing today. That is why the most recent budget, in 2024–25, provided $146 million. This will provide a suite of support for Ambulance Victoria, including medium-acuity transport services and expanding Ambulance Victoria’s secondary triage.

On that point, Ambulance Victoria’s secondary triage system is one of the most advanced in the world, and we deserve nothing less. It diverts 20 per cent of 000 calls to alternative care pathways, reducing the load on our ambos. We are also helping our ambos assess, diagnose and treat Victorians by doubling the capacity of the Victorian virtual emergency department. This has seen over 400,000 presentations, with a diversion rate of almost 90 per cent, and ambos also have directed referral pathways that allow patients to be treated at home. They provide better conditions for ambos, ensuring they continue to deliver world-class services to Victorians.

To wrap up today, I want to say as a proud unionist – I was branch secretary of the Transport Workers’ Union – how important it is to get a fair day’s pay for a fair day’s work. That is why I am so pleased to see we have reached an in-principle agreement with ambos that will see them remain amongst the highest paid in the country. In fact, of the 78 per cent of the eligible voters who voted, 97.3 per cent voted in support of the agreement, which says a lot of things. We will be investing in more staff in the communication centre and in our frontline staff. That includes a new end-of-shift management procedure. It means our ambos will be getting home sooner and more safely. I commend the bill to the house.

Sheena WATT (Northern Metropolitan) (11:52): I am pleased to follow other speakers and make a contribution in support of the Drugs, Poisons and Controlled Substances Amendment (Paramedic Practitioners) Bill 2024. I must say this is a bill that goes to the heart of why Victorians trust Labor governments to govern this state. We know that health care is always one of the most important issues for Victorians, and the Allan Labor government keeps Victorian health care in safe hands. That is why this government has consistently backed our healthcare workers, in particular our nurses, our midwives and our paramedics. We know that they have some of the toughest jobs in our workforce. During the pandemic, Victorians did what we do best: we came together as a community and supported each other to get to the other side. We would not be able to do that without the dedication and expertise of our frontline health workers.

While we tend to think of healthcare workers as superhuman, I know that they also experience very real workload pressures. They too often miss out on precious time with families and friends, and often their own health is impacted by working long hours on shift rotations. I also know that as the population of our great state grows, more and more people will be accessing our world-class health services. We need to take action now to prepare for future increases in services demand.

We want to take the strain off the workforce wherever we can and free up these incredibly important essential workers to get on with the job as much as possible. Paramedic practitioners do just that. They can deliver urgent care in the field so that patients can avoid going to hospital if they do not need to, allowing them to recover at home closer to family and closer to friends. This will free up our emergency departments, relieving some of the strain on our hardworking frontline hospital staff so they can get on with the job of treating people with life-threatening illnesses and injuries. Let us not understate the importance of the bill before us. It is a genuinely life-saving bill that will allow more life-threatening cases to be seen by emergency doctors sooner. I do not know how anyone could consider voting against this. It is a bill that is very close to my heart because, as I have said many, many times, I care deeply about the health care of Victorians, and in particular stroke care. Many of you know I have been joined here by a former member of Parliament, Heidi Victoria, as she hosts a range of Stroke Foundation events in her role there, and can I just take a moment to acknowledge her work.

Paramedic practitioners do such incredibly important work to take the pressure off emergency departments so that they can attend to the people most needing it, including folks suffering a stroke, because as I have said before, time is brain, and every moment that you are waiting for treatment, more and more of your brain cells are dying. So can I just encourage people to go to emergency only when it is indeed that – an emergency. That is why we have got urgent care clinics and others right across our state. Indeed I have been fortunate to work with a number of health-related NGOs across the state, including the Stroke Foundation, and I know from my work there that these organisations will continue to support paramedics in the work that they do and that the inclusion of paramedic practitioners will be invaluable in improving the health outcomes of all Victorians.

Whilst I did take a moment to acknowledge Heidi Victoria and her work, can I also acknowledge others in the Stroke Foundation, particularly the health professionals, and take a moment to join with so many and celebrate the inclusion of the stroke ambulance in our state. I do not know if folks have had the good fortune to see it zooming about here in this part of town, but the stroke ambulance is a wonderful addition to our ambulance fleet and one that I know is there each and every day saving brain and saving lives. So to the organisations that got behind it, including some very exceptional donors that made that possible, can I give you my thanks. I know that it is now being expanded out to Monash, so those folks that are out near the Monash health zone will also have the benefit of the support of the stroke ambulance in our state. I know that in Victoria we indeed have a very proud history and an established track record of investing in Victoria’s health care under the leadership of the Allan Labor government, and we spoke yesterday about investment in women’s reproductive health, another issue that I was very happy to make a contribution on. Let me remind those that are here that we have invested $153 million in a women’s health package to transform women’s reproductive health care across the state, and that means that we can expand those services just about everywhere, including into our regional areas.

Can I just talk a little bit more broadly about our investment in ambulance services. Since coming into government we have indeed invested $2 billion into ambulance services. This has allowed us to put 2200 more paramedics on the road since those opposite were last in government, and we have recruited more than 1300 paramedics over the last three years, and that is why, according to the national report on government services, Victoria has more registered paramedics than any other jurisdiction. So let us take a moment to say that our ambos’ response times are better than New South Wales, they are better than Queensland, they are better than South Australia and they are better than Tasmania. That is something that is worth us all taking a moment to reflect on here in the chamber.

Since the last election, it is worth also noting, we have committed $15.8 million to the training and hiring of 40 additional MICA paramedics – that is the mobile intensive care paramedics – and these paramedics are another type of highly specialised worker who deliver life-saving care to the most urgent cases, and sometimes you will see them right here in our city as they support folks in the CBD. I did see them particularly around the Royal Melbourne Hospital, which is a proud hospital in the Northern Metropolitan Region. I have got to tell you, the MICA paramedics in this state are the best of the best when it comes to emergency health care, and with their higher clinical skill set they can perform these more technical medical procedures.

Business interrupted pursuant to standing orders.