Thursday, 6 February 2025

Bills

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

Debate resumed.

Sheena WATT (Northern Metropolitan) (12:35): It is good to be back here with an opportunity to continue my contributions on the bill before us, and just for the chamber’s benefit that is the Drugs, Poisons and Controlled Substances Amendment (Paramedic Practitioners) Bill 2024. As I was saying before question time, I was talking about our MICA paramedics, and some may recall and some not just how good they are; they are the very best of the best when it comes to emergency health care in this state. With their higher clinical skill set they can perform really technical medical procedures. So any efforts to have more of these highly skilled and trained crew on our roads will ensure that patients are getting the very best care in the most urgent of circumstances.

I am really delighted to continue to make some remarks, and I of course will draw the attention of the chamber to the scholarships that are available, because it is a big thing to undertake a range of studies in paramedic practice and there is now a masters degree available to complement that study. That is available at Monash University, and I am very proud to say that we have got a campus at Monash University in the Northern Metropolitan Region, one that I managed to spend a lot of time at, and that specialises in pharmacy and other health courses there. I am so pleased to see that the very first intake of students commencing their study in the master of paramedic practitioner course at Monash University will commence their study in February 2025. Can I take a moment to wish all those students well who are commencing their studies this month. We will soon see cohorts of students graduating and immediately relieving the pressure on our hospital network, with the first paramedic practitioners set to graduate and be out in the field in regional Victoria in 2026.

The Allan Labor government is also leading the way in paramedic education with the first centre of excellence in paramedicine. Further west this will be delivered, and that centre will be at Victoria University. That is a partnership with Victoria University, which I know has a long and esteemed history in health education, including a great number of nurses that I understand graduate from Victoria University. There will be capacity there to train around 1500 paramedic students every year at the centre for excellence in paramedicine in partnership with Victoria University. The new centre will also provide state-of-the-art simulation equipment, ensuring that paramedic students and also the paramedics that we have already got out in the field get access to this really high-quality real-life educational experience that they deserve. They are really important to me because, as I said earlier, the Northern Metropolitan Region is home to world-class hospitals, hospitals that support Victorians and indeed interstate visitors from all over the nation.

It is fitting that our government is constantly looking for expert advice to improve our healthcare services and keep them in line with global best practice. This bill before us is in line with evidence-based policies that have being introduced in other international health systems. I will draw your attention to the United Kingdom, Canada and the Netherlands. As I said, the Northern Metropolitan Region is home to some of the very best hospitals in the country, including the Royal Melbourne Hospital. The standard of care there is absolutely exceptional, underpinned by the outstanding work of paramedics, who provide really critical emergency care, which will continue to be embedded in the bill before us. The community will be able to access leading standards of health care without needing to leave their home sometimes, which I know does cause an awful lot of distress for a lot of folks – just the very prospect of entering our emergency departments. Can I say that improving access to urgent care is just so critical. If it reduces the strain on our emergency departments, it can only be a good thing. It will enhance patient outcomes, particularly by integrating paramedic practitioners.

Victoria continues to strengthen its commitment to efficient, accessible and high-quality health care, ensuring timely medical attention in the home, in emergencies, in our communities, and that is and can only continue to be a good thing. Part of this is reducing the barriers for community to access critical medicines when they need them most. Something that certainly has happened with nurse practitioners and now will happen with paramedic practitioners is authorisation under the act to administer particular medicines, and that includes the ability to obtain, possess, use or supply prescribed scheduled medicines. Under current guidelines there are sometimes too many points of contact for people accessing emergency health care. I have got to tell you this is exciting if it makes it easier for Victorians to access all the care that they need as soon as they need it. Included in that of course are efforts to reduce red tape and allow paramedic practitioners to get on with the job of saving lives without being hamstrung by the bureaucracy. I cannot support this enough.

Can I just take a moment to reflect on the contribution made on this bill in the Legislative Assembly and draw particular attention to the member for Melton Steve McGhie. Of course he, as may be known to particular members on this side, has been a very strong advocate for changes, particularly during his time as secretary of the ambulance union. He has been a fierce, fierce proponent of paramedic practitioners inside this government, and can I take a moment to acknowledge and honour that. Of course this work has been carried on under the leadership of the current secretary of the Victorian Ambulance Union Danny Hill, representing our hardworking paramedics, who have the wellbeing of all Victorians at heart.

I will just say this is an important reform for our state, one that will have positive effects and will change Victoria indeed for the better. I support this bill so strongly, and I commend it to all here in the house.

Jacinta ERMACORA (Western Victoria) (14:20): I speak today on the Drugs, Poisons and Controlled Substances Amendment (Paramedic Practitioners) Bill 2024. As has been previously referred to by my colleagues, the purpose of this bill is to establish a new class of paramedics, to be known as paramedic practitioners. A paramedic practitioner is defined as a registered paramedic who has completed prescribed postgraduate studies and satisfied the prescribed experience requirements. The bill will authorise paramedic practitioners to practise autonomously in certain key areas – for example, they will be able to obtain, possess, use, supply, sell, administer or prescribe scheduled medicines. The bill also authorises them to access the monitored poisons database, which is SafeScript, in a similar way to a registered medical practitioner or a nurse practitioner.

The Allan Labor government is proud to have always backed our hardworking paramedics. They do an incredible job, and Victorians deeply value the work they do looking after our loved ones and saving lives 365 days a year, and I want to thank them for everything that they do. I am proud of this government’s record of supporting Ambulance Victoria and our paramedics to provide the care that Victorians need in what is often the most stressful moment of their lives: that moment when they have called an ambulance.

Professor David Anderson, Ambulance Victoria’s medical director, said on 19 February 2024:

Our focus is on ensuring Victorians get the care they need, when and where they need it – and the skills of our future paramedic practitioners will better help us achieve this.

This bill is one of the many great initiatives that have come out of the relationship of respect and collaboration. We have just reached agreement with our paramedics which will see them remain amongst the highest paid paramedics in Australia. Under this agreement we will be investing in more staff in Ambulance Victoria’s communication centre to support our front line. And there was enormous support of the union’s vote in favour of the EBA. The agreement also includes a new end-of-shift management procedure, supporting our paramedics to get home sooner and safer.

This positive relationship is reflected in the fact that Victoria will be the first jurisdiction in Australia to establish paramedic practitioners. We learned from the positive experiences in other countries that have paramedic practitioners, in particular, as my colleague Ms Watt said, the UK but also Canada and the Netherlands.

The Minister for Health, Mary-Anne Thomas, said on 19 February last year:

Victoria continues to lead the nation in innovative models of care because our government has always backed our hardworking paramedics – boosting workforce numbers, delivering modern ambulance branches and rolling out advanced training.

And we are making it happen; 25 paramedic practitioners will be on the road by the end of 2026.

Importantly, the first tranche of qualified paramedic practitioners will be developed in rural and regional Victoria. Victorians living in rural and regional areas are more likely to have to travel longer distances to access health care; I certainly know that as one of the long-distance travellers in this chamber. This puts greater strain on the patients, the paramedics who have to transport them to hospital and the emergency departments who have to treat them. Treating people at home where appropriate just makes enormous sense, and to quote again Ambulance Victoria’s press release on 19 February 2024:

This innovative model of care will complement existing health workforce models and support the delivery of contemporary healthcare that meets the needs of our community, particularly in rural and regional areas.

So what exactly is a paramedic practitioner, and what will they be doing? Paramedic practitioners are specialised paramedics with additional qualifications and experience, and I know that in the ambulance service the additional experience is an important part of their qualifications, not just the actual academic qualification. They will be able to independently deliver urgent care in the field without transporting patients to an emergency department. This includes urinary catheter care, wound care and closure, minor infections, dislocations and fractures, and they will also be able to administer and prescribe certain medications. It is an important addition to our healthcare service.

In their submission on 4 September 2024 to the department’s consultation on the proposed changes, the Australian Institute of Paramedic Practitioners said:

[QUOTE AWAITING VERIFICATION]

We feel that implementing such a position would enhance delivery of care given the paramedic practitioners’ higher level of clinical practice and ability to provide longer consults, more patient-centred, associated around keeping patients, if suitable and clinically stable, at home within their community.

This enhancement would also benefit the emergency departments, as many patients that would fit the paramedic practitioner response pathway would no longer require transport to an emergency department. Not only does this alleviate the load for emergency departments, but it also alleviates that unavailability of ambulances during that period where they are transporting a patient, who may simply need a catheter change, to the emergency department.

I do note the concern of the Australian College of Nurse Practitioners about the potential overlap. The experience overseas is that the two roles can be complementary, rather than duplicating or displacing existing roles, and we know how overrun our emergency departments are because of the shortage of GPs. International research has shown paramedics collaborating effectively with multidisciplinary teams. I myself belong to a multidisciplinary team as a social worker in a community health setting, and it works very, very well. The Department of Health will provide advice on collaborative practice models for paramedic practitioners and nurse practitioners.

I also note the issues raised by the Australian Medical Association and the Australasian College of Emergency Medicine about the adequacy of qualifications of paramedic practitioners. This bill will ensure that paramedic practitioners receive comprehensive, masters-level education. The training includes supervised clinical experience akin to that required for nurse practitioners. The course at Monash University is based around a robust curriculum designed by a cross-disciplinary team. It includes clinical placement hours and rotations in acute hospital and primary care settings. This is the incredible strength of ambos, particularly in our state. The knowledge that they hold, the experience that they hold – why would we not harness that, bolster it and use it in a logical way?

As Monash University said in their press release of 4 June 2023, the program:

… will deliver care in areas where people are falling through health system cracks, complementing existing medicine and Nurse Practitioners.

They went on to say:

Paramedic Practitioners will train in advanced assessment techniques, diagnostics, clinical decision-making, treatment planning, and legal and ethical considerations.

The Allan Labor government invested $20.1 million in the 2023–24 budget to establish the role of paramedic practitioner. We worked with Ambulance Victoria, Safer Care Victoria, paramedics, clinicians and unions to develop the pathways needed. The first cohort of paramedics is currently undertaking the nation-leading masters degree at Monash University. A second cohort will begin the course this year. The new degree is being delivered at no cost to eligible paramedics who have more than five years experience in the field. The Allan Labor government is providing scholarships starting in the 2025 academic year. These commitments highlight our ongoing support for paramedics and acknowledge their commitment to their profession.

Since 2014 the Labor government has invested more than $2 billion into ambulance services, recruiting more than 2200 additional paramedics, delivering 41 new or upgraded ambulance stations and establishing a new centre for paramedic medicine in partnership with Victoria University. This is in stark contrast to the track record of those opposite. Victorians remember the chaos that ripped through our ambulance services under their watch. Response times went backwards every year under those opposite despite there being no global pandemic. As a result, those opposite just stopped releasing the data of ambulance response times. Most concerning was that this decline was due to not just their mismanagement of the service but their complete contempt of the workforce of paramedics. Paramedics have not forgotten the disgraceful behaviour of the former Minister for Health David Davis in 2013–14. He wrongly accused them of staging a photo at the Frankston emergency department, a practice that would likely be endorsed by the member for Polwarth – and I do say that is my electorate in Colac – at the Colac hospital. He went around calling frontline paramedics thugs, liars, militants, stooges and hardline. When you compare our most recent budget to their last budget, we have invested $1.4 billion into ambulances compared to $661.9 million in their budget. The secretary of the Victorian Ambulance Union summed it up best when he said:

The Liberals back then were the virus, the Liberals back then were the factor …

I don’t ever want them near my members again.

The Allan Labor government takes a different approach. We are working with our health services to determine what they need. For example, the government is supporting the training of 40 additional mobile intensive care ambulance paramedics – that is the MICA qualification – with Ambulance Victoria welcoming their largest cohort of MICA trainees in history. These investments are as important as ever, with the latest quarterly data revealing that paramedics attended close to 100,000 code 1 call-outs. We also committed to another Australian first, the first centre of excellence in paramedicine, and this is being delivered in partnership with Victoria University, who are co-contributing $10 million to the centre, making it a $20 million total investment. The centre will have the capacity to train around 1500 students per year to become the next generation of paramedics. This partnership between Victoria University, Ambulance Victoria and the government will be located in the heart of Melbourne’s west. We know there is more work to be done to get us back to the record response times achieved prior to the pandemic, but this government knows this will only be achieved by working with our paramedics, not against them. I heartily commend this bill to the house.

Tom McINTOSH (Eastern Victoria) (14:35): I am absolutely delighted to stand and speak to and support the Drugs, Poison and Controlled Substances Amendment (Paramedic Practitioners) Bill 2024. It is a historic piece of legislation. I took the time to have a listen to the contribution of one of our colleagues here Mr McGhie, the member for Melton, who of course was the secretary of the union before coming into this place. I listened to him put into context what it means for workers, what it means for Victorians, what it means for all of us, the work that went into developing this over the years and to be able to see workers being trained to go out into these roles, which are particularly going to benefit regional and rural Victorians. I really enjoyed listening to his contribution because it really shows that to deliver for people, to deliver for communities, it starts with a set of values that can inform a vision, can inform a plan and can inform policies – that you do the work to make legislation to make real-life differences in people’s lives, like this. I want to start with a tip of the hat to Steve, the ministers that have held the portfolio over that time and of course the members both within the union and the workers and anyone who has looked at examples from around the world of how this can be done and why it should be done and the benefits that it will bring to all of us to bring us to this point.

Paramedic practitioners are specialised. They are able to independently deliver urgent care in the field without the need to transport, not only taking pressure off our hospitals but also assisting people more quickly, which for any of us who have had to call an ambulance – and I had to do this within the last 18 months for somebody – having that skilled support arrive is such a relief in what is a very difficult and traumatic time. To implement this commitment, the Allan Labor government invested $20.1 million in the 2023–24 budget. As I touched on before, we have established Australia’s first ever paramedic practitioners masters degree at Monash University. These 30 graduate students who began in 2024 will begin soon, in the coming year. To support those undertaking the course, the Allan government is providing scholarships over four years starting in the 2025 academic year.

Paramedic practitioners are used in other international health systems, as I said before, looking at other best practice around the world – the UK, Canada and the Netherlands. I think this sits squarely amongst our commitment to healthcare workers, whether that be nurses and recognising pay gaps, historical pay gaps for our nurses and midwives and dealing with that, or having a fundamental belief in the need for good pay and conditions for our frontline service workers for the incredible work they do. We know that for those opposite their economic policies are to drive down wages. We know that their fundamental starting point is not one of going out and looking to support our workers, the ones that do so much for our state. When you look through history, whether it is the 1990s when there were 200,000 workers out the front against Kennett or whether it was David Davis in his stint as health minister and the disdain he showed to the health workforce, I am proud to be part of a party that has in our DNA an absolute commitment to workers.

This bill will include a definition of a paramedic practitioner in the act, and a paramedic practitioner will be defined as a registered paramedic who has completed a prescribed postgraduate study and satisfies the prescribed experience requirements. To enable paramedic practitioners to practise autonomously, the bill will provide authorisation under the act equivalent to a nurse practitioner, including the ability to obtain, possess, use, supply, sell, administer or prescribe scheduled medicines; to allow paramedic practitioners to access, use and disclose information on the monitored poisons database; and to require that paramedic practitioners check SafeScript before supplying or prescribing a monitored poison, similar to a registered medical practitioner or a nurse practitioner.

As I said, there are a number of ways we are supporting our ambos and indeed our health workforce, and since coming to government we have invested an additional $2 billion into our ambulance services. We have grown AV’s on-road staff by more than 50 per cent, with more than 2200 more paramedics on our roads since the Liberals were last in office. Again, something Steve McGhie touched on in his contribution is the incredible uptake in that workforce. Our workforce responded to increased demand, with more than 1300 paramedics recruited over the past three years, which given all the global workforce pressures that exist I think is an incredible, incredible outcome. According to the same report on the national government services, we had more registered paramedics than any other jurisdiction and Ambulance Victoria’s response time is better than that of New South Wales, Queensland, South Australia and Tasmania. Again, coming back to the point, within two years of us coming to government we had ended the war of those opposite with our paramedics and ambulance response times improved to 80 per cent of code 1 cases responded to in 15 minutes.

We know our paramedics are dealing with record demand, but despite this, the most recent quarterly data shows paramedics are arriving 16 seconds faster compared to the previous quarter, and to help our paramedics manage this demand the most recent budget provides an additional $146 million to support a range of operational priorities for Ambulance Victoria, including medium-acuity transport services and expanding AV’s secondary triage.

I also want to talk about the investment we are making in infrastructure, and during a contribution I made this week I was talking about the importance of supporting the workforce with their pay and conditions but also the infrastructure equipment around them. I am really fortunate to have had the opportunity to visit our paramedic teams and see the investments that we have made in their facilities. Across Eastern Victoria I was able to visit the team at Mornington in their new building. We have got upgrades in Foster. I have caught up with the teams in Paynesville, Yarram and Morwell. There are new stations to house these teams, who are doing such incredible work that when you dive in and you talk to residents within those communities and the pool of small towns that benefit from them, they are so incredibly, incredibly appreciated. At other times I have been able to catch up with the team up at Maffra and surrounds. It is just a really rewarding time personally, and having known people when I was younger working in the area, you just appreciate what it means for them as a commitment and the sacrifices they make personally and for their families.

At the last election we also committed $15.8 million to the training and hiring of 40 additional mobile intensive care paramedics, another type of highly trained paramedics who deliver life-saving care to the most urgent cases. Our MICA paramedics are some of the best in the world when it comes to emergency health care, managing complex head injuries, administering intraosseous – intra-bone – drugs, treating life-threatening chest injuries and providing advanced management of cardiac conditions. They have a higher clinical skill set and can perform more technical medical procedures. Having more of these highly skilled crews on the road will ensure patients are getting the best care in the most urgent circumstances. We are beginning to see the benefit of this commitment with, this year, AV having the largest ever cohort of MICA trainees in AV’s history. This means we will have more of our highly skilled ambos available to respond to the most urgent cases.

Also, there is our commitment to another Australian first: the first centre of excellence in paramedicine. This is being delivered in partnership with Victoria University. The centre will focus on training the next generation of paramedics, providing advanced teaching methods. With the capacity to train around 1500 paramedic students each year, the new centre will also offer state-of-the-art simulation equipment, ensuring the highest quality real-life educational experience for undergraduates, students and paramedics in the workforce. These commitments highlight our ongoing commitment to paramedics and acknowledge their commitment to their profession.

While those opposite might like to laugh and smirk, when you talk to paramedics, they know which side of politics will support them in their pay and conditions and respect the incredible work they do for people in need – the incredible work that touches loved ones of all of us at various times throughout our lives. They know that it is Labor that will invest in the infrastructure to ensure that they have the buildings and the equipment to work with to deliver that world-class treatment. I am really proud to be part of a government that is delivering Australian firsts because, as I said at the start of my contribution, it is the values we have, it is the values that underpin the planning, the policy and the investment, that can take something from being an idea and over the years develop it into something that results in workers being trained to deliver Victorians continually better health services. I know personally and I am sure on this side it is something that collectively we stand together on, as one, and we are very, very proud of that.

Ingrid STITT (Western Metropolitan – Minister for Mental Health, Minister for Ageing, Minister for Multicultural Affairs) (14:48): I thank all members for their contributions in relation to this bill and also welcome the very broad support that this bill has across the chamber. At the last election the Labor government was very proud to stand with our paramedics and announce that we would establish a nation-leading paramedic practitioner role in Victoria, and with this bill we are delivering on that commitment. We have already invested over $20 million in the 2023–24 budget to support the training of our first paramedic practitioners, and with this bill we are providing the legal framework to get paramedic practitioners on the road. I want to acknowledge our hardworking paramedics, who work each and every day to support Victorians with the health care they need, often at their most significant hour of need.

The introduction of paramedic practitioners opens up a new pathway for our paramedics to upskill and recognises the important role they play in the health system. This innovative, Australian-first model of care will complement other health workforce models, including nurse practitioners and general practitioners. This mirrors how paramedic practitioners are used in other international health systems, in particular the UK, Canada and the Netherlands. Having paramedic practitioners on our roads will mean better care and treatment options, particularly for rural and regional Victorians, where they will take pressure off primary and urgent care.

With respect to comments regarding the number of trainees, I want to emphasise that this is the first cohort of trainees, which will be coming online in 2026. I also want to emphasise that this is a national first and that the role and place of paramedic practitioners will establish itself within our system over a period of time. It is also important to acknowledge again that paramedic practitioners will play a role in rural and regional communities initially and that this will make a positive impact on access to urgent care. In essence this is enabling legislation – the beginning of the role not the final rollout. I understand that there will be some questions in committee, which I would be very happy to take, but I do commend the bill to the house.

Motion agreed to.

Read second time.

Committed.

Committee

Clause 1 (14:51)

Minister, I raised in my contribution to the debate some concerns from various stakeholders. I am just wondering what engagement the government had with stakeholders, who were they, and specifically I reference the AMA and also the Australasian College for Emergency Medicine. Could you provide the committee with feedback on the conversations you have had with those two particular stakeholders, given they have some specific questions, and which other stakeholders the government spoke with?

Maybe if I deal with the second part of the question first and just give you a snapshot of the organisations that we did consult with. I think that there was quite extensive consultation with peak industry representatives, and there was a consultation paper that was produced called the Introduction of Paramedic Practitioners, which formed the basis for the consultation that the Department of Health undertook. I should say that obviously the consultation process followed the approval in principle of the bill so that we could get that early indication from not just peak bodies but also representatives in the workforce about the model.

We consulted with senior representatives from the following organisations: the Australasian College of Emergency Medicine, the Australasian College of Paramedicine, the Australian College of Nurse Practitioners, the Australian College of Nursing, the Australian College of Paramedic Practitioners, the Australian College of Rural and Remote Medicine, the Australian Medical Association, the Australian Nursing and Midwifery Federation (ANMF), the Health and Community Services Union (HACSU), the Pharmaceutical Society of Australia, the Royal Australian College of General Practitioners, the United Workers Union, the Victorian Ambulance Union, the Department of Education, the Department of Energy, Environment and Climate Action, the Department of Families, Fairness and Housing, the Department of Government Services, the Department of Jobs, Skills, Industry and Regions, the Department of Justice and Community Safety, the Department of Premier and Cabinet, the Department of Transport and Planning, the Department of Treasury and Finance and Victoria Police.

If I can take you to some of the specific feedback from the AMA first. The AMA did express concerns regarding the introduction of the paramedic practitioner role, and they raised a number of key issues around how the paramedic practitioner role would work within the system. I think that the government has taken the view that this is to be a complementary role, and not to duplicate the work of a general practitioner, but it will also, we say, take pressure off the primary health system by having another role in the system that is able to take some of the less complex care away from GPs. I can probably give you –

Georgie CROZIER: I can ask specific questions, if you like.

Ingrid STITT: Yes, that would be probably easier, I think.

These are some of the questions that came from the AMA to me, so if I could get some responses. They asked: what evidence supports the appropriateness of paramedic practitioners expanding into roles traditionally reserved for medical practitioners, particularly concerning chronic disease management and prescribing rights?

Just one second, Ms Crozier. I have just got to check with the box. I have got a number of different indexes here, so just bear with me for one sec. Apologies.

Paramedic practitioners will focus on providing urgent and unscheduled care. They will be managing acute presentations and supporting chronic disease management within the scope of practice. The example that was used in the consultation paper was a paramedic practitioner would attend to a patient with cellulitis by ensuring the patient is not at risk of systemic changes, treating a mild case of cellulitis and referring the patient back to their GP for ongoing management and monitoring. This would ensure that the condition improves and the patient’s diabetes is managed appropriately. So paramedic practitioners in that scenario would stabilise patients and, as required, refer them back to their GP or to the emergency department as appropriate. Their training would include developing skills in clinical assessment and recognition of red flags that may indicate serious underlying conditions. Paramedic practitioners will have protocols for referral to GPs or specialists when conditions fall outside their scope of practice or when ongoing management is required. This collaborative approach aims to enhance patient care without compromising patient safety, experience or care.

My question was: what was the evidence that was given to government? Was there any modelling done? Was there any evidence? What prompted the government to do this? Was it just because the union wanted it, or was there some evidence to suggest this was required? Where is that evidence to back up the government’s initiative?

Well, it certainly was not as you put it, Ms Crozier, just because the union wanted it, although I will say that the ambulance union has a very deep commitment to making sure that we are skilling up our paramedics in a way that means that they can support the broader health system not just in emergency situations but through innovative models like the paramedic practitioner role. So of course globally healthcare systems are grappling with some of the same issues that we are grappling with here. There is huge demand for health care. That is not a phenomenon that is sort of isolated to Victoria or Australia; that is the international experience, and that is leading to quite a bit of strain on emergency departments. We obviously looked at other models internationally in the UK and in Canada and in the Netherlands. This paramedic practitioner model in the case of the UK has been in place for around 20 years, so they have got a much more mature model to look to. The evidence is pretty strong that it does help build advanced education and expanded scopes of practice and that paramedic practitioners in those jurisdictions are able to manage urgent care conditions in patients’ homes or in the community environment and indeed take pressure off emergency departments. The published evidence highlights the value of paramedic practitioner models in delivering patient-centred cost-effective care. Of course they were all issues that the department looked at very closely.

I am not having a go at the paramedics; I am just trying to understand how it came about. I know that they do phenomenal work. I know paramedics. They do extraordinary work. So it is not having a go at any of them. What I am trying to understand is that evidence. What I think you have said is you have looked at those models from the UK, Canada and the Netherlands and seen that they have been in practice for quite some time, hence you are bringing it in here. Given their experience, can I ask: how does the government plan to address the concerns that have been raised by medical professionals that this initiative undermines the principle of the right care being delivered by the right professional at the right location?

Obviously there will still be much work to be done as we settle the scope of practice and also the model as it is rolled out. Bearing in mind that the first group of paramedic practitioners will not be on the road until late 2026, there will be time to speak with all of the key stakeholders. It is certainly the intention of the department and Ambulance Victoria to continue to work with those representatives of other parts of the health system to make sure that we are building a robust model, including all of the safeguards that you would demand of this sort of system.

Can I just add to my previous answer that international studies have reported between a 14 and 78 per cent reduction in emergency department transport for low-acuity cases managed by paramedic practitioners compared with standard paramedic care. That is pretty strong evidence to suggest that this can take a lot of pressure off our emergency departments for those patients that it may not be necessary or appropriate for them to be taken to an emergency department by an ambulance, and this additional resource will help in that regard.

That brings me to another question that I have. The college for emergency medicine raised a number of issues. Obviously you have just said it is a start. The rollout of 25 practitioners cannot possibly have an impact on EDs; right? It just is not going to have an impact, is it, on the EDs? Because these are going to be placed in rural and regional areas, and it is not going to make a jot of difference for metropolitan EDs. They say the college is yet to see any evidence to suggest that the paramedic practitioners, especially with the number of positions and the breadth of the health system they intend to cover, could possibly make any meaningful reductions to the ED workload. You are saying the first ones will roll out in 2026. What are the projected numbers you are talking about so that, as you have just argued, there will be an impact on EDs? How many of these paramedic practitioners will that take, and at what point will that have an impact on our EDs?

The first 25 paramedics will, as you say, be based in rural and regional Victoria. They will be treating patients in place and delivering a range of benefits not only to patients but also to their families and the system. I do not know that anybody is arguing that it is not a priority to place the first group predominantly in regional and rural settings. It will minimise transport to EDs in rural and regional Victoria, where the distances tend to be a lot further than they might be in metropolitan areas. But Ambulance Victoria’s (AV) role in our system is obviously more than just transporting patients to hospitals and emergency departments; it is focused on connecting people to the right care. This initiative builds on that effort. The paramedic practitioners are really just one way that we are working to reduce emergency department workloads. We have got the secondary triage services, which connect around 20 per cent of all 000 ambulance callers to alternative providers. We have got the Victorian Virtual Emergency Department, which has seen over 400,000 patients and supported 85 per cent of those patients to avoid an in-person visit, and 29 urgent care clinics open seven days for early-to-late walk-ins for non-life-threatening immediate health care.

I guess the view that the government takes in relation to this is that this is another way, along with a suite of other measures, to try and alleviate that pressure on the emergency department, and those international studies do show that there is a significant reduction in ED transport for low-acuity cases where there is a paramedic practitioner model in place compared to the standard paramedic care. There is the international evidence; those systems are much more mature. We are obviously just starting here in Victoria, and that model will have to be built out, bearing in mind that there is a period of time and a pipeline that needs to be built because of the study that paramedic practitioners quite rightly have to undertake.

Minister, I suppose where I am coming from is you have just highlighted that the models that have been in place in Canada and the UK and the Netherlands are much more mature, but as you correctly point out, we have got virtual EDs and we have got other models that are taking on those low-acuity cases. Those other countries possibly do not have what you are referring to as the history of how the paramedic practitioners have been operating, and those countries possibly do not have the same level of support as what we have been developing here over the last few years with the virtual EDs and the like. It goes to the point that they are low acuity, as you have just said. So I have got a couple of questions. When these paramedic practitioners attend somebody’s home, will there be two paramedics, and will they both be paramedic practitioners or will one be a regular paramedic and one a paramedic practitioner? How will it operate?

I think that what I said in my contribution just before we came into committee of the whole was that this is really the enabling legislation, the bill that is before us today, and the model needs to be built. We have been very up-front about the fact that we will work closely with all different parts of the health system, including the stakeholders who engaged with the consultation process, about how we build the model. The exact answer to your question about whether paramedic practitioners would be alone or in a team is the work that will be done next with those stakeholders and with the various parts of the health system. That is to be worked through.

When will that model be complete?

We know that we have pretty tight timelines to be ready for the first group of paramedic practitioners coming out of their training and needing to have supervision on the job in the first instance, so it will be before the end of 2026.

I am thinking it through. So you are saying they need supervision, yet you cannot tell the committee whether regular paramedics will be taken out of the system to assist those paramedics that need supervision. I am just trying to work out what impact it is going to have on the regular AV workforce given that is all to be worked through. Surely the government had some idea, and surely you have looked at the models that you referred to from overseas and whatever they have. I am a bit perplexed as to why the basics like this have not fully been spoken about. It seems like the cart is before the horse, given those paramedics are going into specialist training, yet they have not fully understood how it will operate for them. Surely they need to understand their backup and who is going to be driving ambulances if they do need to transport patients to an emergency department or, as you say, to primary care or somewhere else. I am just wondering why that has not been thought through.

Well, I do not accept that it has not been thought through, Ms Crozier. I guess what I am saying is this is an additional resource. It is not about tying up existing resources. This will provide additional capacity within the AV structure and workforce. There will be a lot of work done to settle the scope of practice, and that requires work between AV and other parts of the health system, including our emergency departments, including primary care, including community health and the like. Nobody is suggesting that that has not all been thought through, but the actual work to build that appropriate model needs to include all those parties, and that is work that the government has committed to doing in the lead-up to the first group of paramedic practitioners being on the road in 2026.

We look forward to getting a progress report on it.

Another concern from the college of emergency medicine says the consultation paper does not address the question of the program’s aim to provide primary care. Again, the question is raised by an important stakeholder. Will they be working the same hours in which primary care services, GPs and urgent care centres are usually available, or will they exclusively work night shifts, when they are most needed?

Obviously the operational matters that you speak of in terms of hours of operation and the like are not details that are available now, but what I will say is that the paramedic practitioner role is expected to interact with nurse practitioners, with MICA paramedics, with general practitioners and with other relevant professionals. As I have already said, the paramedic practitioner role will enhance the delivery of health care by augmenting the work of these other health practitioners, particularly in rural and regional areas. The paramedic practitioners will be an extension of the patient’s GP and act alongside existing primary care providers. They will be integrating into those primary health teams to ensure efficient and effective patient management, and paramedic practitioners will deliver healthcare services where they are needed the most, and I guess that that will have to be adapted as the model is rolled out. But in other jurisdictions the evidence suggests that paramedics with targeted advanced education and that adjusted scope of practice can actually effectively make a really important contribution to the broader health system in a complementary way rather than duplicating or displacing any other health professional in the system.

Minister, have the areas in rural and regional Victoria been identified where these 25 paramedic practitioners will be located as yet?

The initial focus will be on regional and rural areas, and we want to make sure the model remains flexible to address that evolving need, and that includes potentially metropolitan applications in the future, but we have been clear that regional and rural is a priority in the first group. The department will consider operational models where paramedic practitioners can be dispatched directly to suitable cases, reducing duplication and improving response efficiency. So that approach will be further explored in the development of those final operational details.

Minister, what weight has been given to expert feedback suggesting that this initiative may lead to fragmented care and suboptimal patient outcomes?

Obviously the priority of the Allan Labor government is to make sure that all of our investments in the health system, including our paramedic ranks, are about enhancing patient care and health outcomes for Victorians.

So how will the government ensure that this initiative does not result in increased costs for the healthcare system due to fragmented care or adverse patient outcomes?

Ms Crozier, I think that will be resolved through working really closely with other parts of the health system, and that is certainly the commitment that has been made to all of those stakeholders who have provided that important feedback. And we need to make sure that people have confidence in the model and that any concerns that they have got are adequately addressed during the work that needs to go into the operating model, and that is certainly the intention of the department and Ambulance Victoria as we get ready to roll out this important role.

We know that we have a significant workforce shortage with healthcare professionals in this state. Is this initiative primarily a response to those shortages, particularly because you have highlighted, or the government has highlighted, rural and regional areas, where we know there are worse response times for ambulance, a lack of primary care and now with the networks there are going to be greater shortfalls for country and regional Victorians? So were there any alternative solutions the government considered to address the workforce shortages without compromising care standards?

I think, Ms Crozier, we have ensured that we have got a record number of paramedics on the road. Since coming into government we have had a very sharp focus on increasing the number of paramedics. This is an initiative that is in response to building alternative models of providing care whilst at the same time taking pressure off our busy emergency departments. You would be aware, as a former health professional, how the system needs to constantly evolve and look at new best practice ways of operating, and I think that is what has driven the introduction of paramedic practitioners. It is about innovating; it is about looking at the evidence overseas but also trying new ways here in Victoria to make sure that Victorians get the health care that they need and deserve.

Will there be a review of this program, and if so, when and how will it be undertaken?

The department is partnering with Ambulance Victoria and will develop a comprehensive healthcare utilisation and economic monitoring and evaluation framework that will assess the impact of the paramedic practitioner role. The evaluation will include impact on reducing demand on our – as I have been talking about – busy emergency departments. Like any health service, AV will continuously monitor patient safety and outcome measures to understand any opportunities for improvement as we roll out this model.

I was going to go to a couple of causes, so I might as well just ask them now while we are speaking about general things. Clause 9 talks about SafeScript. That is a very important tool so that patients’ medications and the like can be monitored so they are not being abused, as we know, including the prescription history. On Clause 9, the explanatory memorandum states:

The monitored poisons database, known as SafeScript, is a clinical tool that provides access to a patient’s prescription history for high-risk medicine to enable safer clinical decisions.

In terms of that SafeScript – and I know that the bill says obviously there are a number of drugs under the current schedules, and they can be added to just like for the nurse practitioner, so I understand that. But are there any concerns around the SafeScript program and paramedic practitioners, or is the government completely going on the model from the nurse practitioners around the SafeScript provision? Is that the case?

SafeScript – I am not telling you anything you do not know, Ms Crozier – is computer software that provides prescribers with a comprehensive history of the high-risk medicines patients have been prescribed to help prescribers make better decisions about patient care and to keep patients safe. The purpose of SafeScript is to coordinate care by and between clinicians to deliver the best treatment for the patient, not to instruct clinicians on what to do or decide whether a medicine should or should not be prescribed to a patient. This remains the prescriber’s clinical decision. As registered paramedics, paramedic practitioners will also have obligations under the Australian Health Practitioner Regulation Agency’s (AHPRA) mandatory notification scheme if they have concerns about a clinician’s safe prescribing. They may also seek clinical support through the drug and alcohol clinical advisory service, which can provide advice for managing complex patients.

Thank you for that clarification. I only raised it in light of what I raised in my debate about the IBAC finding and the misuse by practitioners. I think all of those recommendations have been addressed – I do not know that – from that IBAC report from Operation Tone. Are you able to confirm that?

Do you mind if I just give my trusty adviser her laptop back? Then I will come right back to you.

No, not at all.

I can confirm, Ms Crozier, that Ambulance Victoria accepted all recommendations in full from that report. They have already made a number of improvements, including introducing a new alcohol and other drugs policy and procedures, including testing of all new recruits. They have strengthened the management of professional conduct reporting and investigation practices and increased drug security and auditing, including measures to make branches and medicine rooms more secure.

Thank you very much for that clarification, Minister. Just one last question, if I may. Clause 10 talks about how the paramedic practitioner must take all reasonable steps to check the monitored poisons database before prescribing or supplying a monitored supply poison to that person. That is an important part largely in what we have been discussing around the misuse of medication but also for the patient. What does the practitioner do if they find some anomaly with that? When they are taking reasonable steps, what are those reasonable steps? And when they are monitoring or checking the database, what do they do if they find an anomaly? Is it similar to the reporting that other GPs and others have to undertake?

In line with my previous answer, there are still responsibilities under AHPRA for notifications to be made.

Clause agreed to; clauses 2 to 26 agreed to.

Reported to house without amendment.

Ingrid STITT (Western Metropolitan – Minister for Mental Health, Minister for Ageing, Minister for Multicultural Affairs) (15:29): I move:

That the report be now adopted.

Motion agreed to.

Report adopted.

Third reading

Ingrid STITT (Western Metropolitan – Minister for Mental Health, Minister for Ageing, Minister for Multicultural Affairs) (15:29): I move:

That the bill be now read a third time.

Motion agreed to.

Read third time.

The DEPUTY PRESIDENT: Pursuant to standing order 14.28, the bill will be returned to the Assembly with a message informing them that the Council have agreed to the bill without amendment.