Tuesday, 1 April 2025

Bills

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

Second reading

Debate resumed on motion of Harriet Shing:

That the bill be now read a second time.

Georgie CROZIER (Southern Metropolitan) (13:55): I rise to speak to the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. I am very pleased to be able to rise and speak to this bill, given my past experience of being a nurse and also a midwife and understanding the extraordinary work that they do every single day in our hospitals in this state and in this country. Although I have not worked in an intensive care unit for some years, I can fully appreciate the extraordinary work that they do in the emergency departments, which is what this bill largely covers off. I will go to the purposes of this bill, but I want to say that I have been very pleased to have spoken to many, many clinicians over recent months, including nurses and midwives, as well as many others who are reaching out to me around a number of their concerns that are arising in the health system.

This bill goes to an election commitment. It was part of a longstanding commitment by the Andrews Labor government, and now it is carried on by the Allan Labor government. In 2015 the then Andrews government introduced the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Bill 2015 to enshrine in law the minimum staffing level for nurses and midwives in the Victorian public health system. These ratios were previously part of the nurses and midwives enterprise agreement. Since then there have been two phases of amendments to the ratio requirements, in 2019 and 2020. This is the third tranche of acknowledgement of the ratios, and that is what this bill is addressing. Over the past five years there have been previous amendments, which include ratios in specific settings, including stroke, haematology and oncology wards; palliative care; aged care; birthing suites; and emergency departments. As I mentioned, this bill is the third phase, which was promised by the government and taken to the 2022 election, and it introduces higher minimum staffing levels in intensive care units, higher dependency units, coronary care units and emergency departments.

As I said, I have worked in some of these areas but not for many years, and I am sure that the workload that many of our clinicians are seeing is very extensive, given the demand and what they are required to do on a daily basis. We all acknowledge that, and we all want to encourage the ongoing work that they do and encourage more Victorians to come into this wonderful vocation, as I did. I spent many years in it, especially in the public system, and it was an extraordinarily rewarding experience that I had. I am very, very grateful to all of those that supported me and likewise to have been able to support the many nurses and midwives that came under me in the senior roles that I had.

This bill seeks to improve patient care and safety with legislative requirements for more nurses and midwives across the public health system. It makes changes to the existing ratio requirements for level 1 and level 2 hospitals. In level 1 and level 2 ICUs a one-to-one nurse-to-patient ratio will be required for occupied ICU beds on all shifts. That is really a given; that has always happened. When you have somebody in an ICU generally it is a one-to-one ratio and there is one nurse to that patient. But this bill is formalising that longstanding practice of having one nurse to one patient in the intensive care unit.

In level 1 and level 2 ICUs there are new requirements that are being introduced to have team leaders and ICU liaison nurses and a nurse in charge of the unit. There has been some confusion around this, and I want to come to that later in my contribution. What the bill also does in terms of the changes is it sets a one-to-one nurse-to-patient ratio for each resuscitation cubicle in an emergency department on a morning shift – currently it is one to three – bringing morning shifts in line with afternoon and night shifts, and a one-to-four midwife-to-patient ratio in postnatal and antenatal wards on night shifts – currently it is one to six – in level 4 services which are part of larger metropolitan services and level 5 and 6 services under the maternity capability framework.

I do understand how, especially during a night shift, everything can be absolutely fine in a postnatal ward or an antenatal ward and you can suddenly find yourself addressing the needs of the patient, given somebody going into premature labour or having a situation where they are needing to be delivered or even post delivery – a caesar – where they need more nursing care than a normal delivery. Those requirements can change very quickly; we know that. That is a normal hospital environment. It is very fluid. Things need to be addressed and they need to be looked at on a shift-by-shift basis – sometimes on an hour-by-hour basis – given the nature of a patient’s condition. So it is very important that there is some flexibility in the system to enable those requirements to be met. But what this does is it really ensures that the ratios are in place to ensure that, as the bill suggests, safer patient care is adhered to.

What the bill also does is legislate an in-charge nurse on night shifts in standalone high-dependency units or coronary care units. Those high-dependency units or coronary care units are similar to ICUs, but they are specific around the high-dependency needs; it is greater care than is required in a ward situation. Likewise for the coronary care unit, which is looking after people that have got specific coronary care needs or are being nursed in relation to those conditions, they do not perhaps require an intensive care unit, which is a very, very sophisticated ward with extraordinary amounts of equipment and expertise, with doctors, nurses and other experts in the field, physicians and other specialists as well, that come in and really look at a patient’s needs.

The bill also updates the list of hospitals in the schedules to the act to reflect the changing names of some of those services, and that is in relation to some of the government’s processes where they are amalgamating services or bringing services together – and we have seen some of those reflected with their name changes in this.

Clause 5 of the bill amends the act to apply the rounding method set out in section 12 of the act to determine the new staff requirements in level 1 and 2 hospitals. That has been a specific concern and they – especially the Australian Nursing and Midwifery Federation (ANMF) – have said part of the endeavour for this bill is to change those rounding methods so that they are rounding up, not rounding down. That will be more reflective of the requirements for the nurse–patient ratios and, as I say, provide an ability for the nurse or midwife, as the case requires, to comply with the ratio.

Clause 6’s amendment to section 20 of the act sets out the new staffing requirements for emergency departments. Whilst I am on emergency departments, obviously they are highly sophisticated areas of health care too – very, very busy areas – and what we are seeing, which is alarming, is the extent of violence that is occurring in our emergency departments. We had a situation last week at the Alfred – a very, very concerning situation – where somebody had got through triage with a box cutter knife and other things and really could not be contained. It took 15 minutes for police to arrive and to bring this person under control. It is very concerning that the major hospitals are having code blacks and code greys on a regular basis. But it is not just our major tertiary hospitals in Melbourne, it is right across Victoria where these acts of violence and aggression within our emergency departments are occurring. I do believe the government needs to be addressing these concerns, because staff are feeling very vulnerable and quite unsafe. I hear it all the time; they are coming to me.

The parents of some of these staff are saying, ‘I’m worried about my daughter’ – or whoever it is – ‘going to work given the level of violence,’ and that has been communicated to me on more than one occasion.

The amendments in clause 7 of the bill set out the new staffing requirements for ICUs in level 1 and level 2 hospitals respectively. Clauses 8 and 9 amend sections 21 and 22 by setting out the new staffing requirements for high-dependency units and coronary care units. Clauses 10 to 13 amend section 30(1)(a) and (b) and add new sections 30A and 31B, which set out the new staffing requirements for antenatal and postnatal wards. I have alluded to how busy those wards can be; they can change very quickly. The above clauses include the phasing in of the new ratios in three stages to give health services time to implement staffing changes – well, that is the government’s intention. The government is saying that hospitals must have 25 per cent of the additional staff required in place from the day after royal assent, 75 per cent from 1 December of this year, 2025, and 100 per cent from 1 July 2026. I do want to delve into this issue a bit more, because I have received correspondence from a health service that explained this. It says:

The implementation of the recent amendments to the SPCA remains fluid with ongoing discussions between us, the Department of Health and the ANMF.

The exact requirements around how this is going to be achieved are ongoing and yet to be finalised. They are talking about the minimum standards of staffing that they need, and they are saying that they could be anywhere between four full-time equivalent staff and as many as 14. That is quite a variation, and I am not sure that there has been much clarity around how that might actually be realised in the real world once this bill is passed. I will be asking in committee a little bit more around those issues around staffing.

Clause 14 removes the application of local dispute resolution for breaches of the new ratios until 30 June 2026, and that is to allow sufficient time to recruit the additional nurses and midwives that are required as set out with the legislation.

In the bill briefing that the opposition had I asked a series of questions around things that were concerning me. The government has said there is $101 million that has been provided for this, but where is that in the budget papers? The question was taken on notice but has not been answered. Already we know that health services right across the state are under enormous strain, and they are finding that they are really being pressured with their budget constraints. We know that last year there were budget cuts and then there was a Treasurer’s advance of $1.5 billion to fix up the mess of what happened in last year’s budget. There is just enormous pressure within our health system. We know that hospitals are struggling to pay bills on time, so there is a real concern around the financial element of this and it is unclear how the allocated funding will be sufficient to meet these higher costs. As I have just outlined, one health service has said it is very variable and they have got to find these staff but with what allocation? They are doing well as it is, but it can put additional pressure on their budget.

On workforce capacity, again, when asked what modelling has been done and about the impact on the broader health system, especially given the nurse shortages that are occurring, the response was, ‘Well, it’s up to the individual health service to be operational,’ which I understand – it is. But that is my greatest concern. I think a health service should have the flexibility and the autonomy to be able to manage their own staffing, but there are concerns about how that can be achieved given the requirements of this legislation and what is being asked of them.

In the briefing I was also concerned about which hospitals cannot meet the current ratios, because we know that happens – everybody knows that happens. Again I have had no response. What about the additional workforce required? In the briefing the department was unable to provide that figure.

These are all legitimate questions that should have been able to be answered, and that was asked six weeks ago when we first had the briefing, and still we have got nothing. So I do want the government to clarify these issues in the committee stage, because I do think they are reasonable, legitimate questions that, when we ask them in a bill briefing, we have the courtesy to have a response to some of these questions. They are incredibly important, and I was disappointed not to receive any from the follow-up that was assured to be undertaken.

The bill allows nurses in ICUs to care for up to two patients if they are not critically ill, and we understand that there is that flexibility, and I really understand that, because sometimes they might be stepping down and going out into the ward or stepping down to a high-dependency unit or whatever. So it really is subjective, being critically ill; obviously when you are in those units you know what a critically ill patient is, yet it is not terribly well defined in this bill.

The government’s consultation, I think, has been problematic, and that has been evident over the last few days where I have received dozens and dozens of emails from nurses working within intensive care units, and I received correspondence from the union last night. But I have spoken to the Australian College of Critical Care Nurses, who wrote to me around their concerns. They have said:

Many Nurse Unit Managers of Intensive Care Units in Victoria have been in contact with us to express their confusion over the intent and language used in the proposed legislation, and their concerns at the potential detrimental impact on staffing resources, and ultimately, safe patient care.

That is exactly what this bill is trying to achieve. So the ACCCN, the College of Intensive Care Medicine and ANZICS have all written this combined letter to me, and they go on, and their concern is that:

… the ICU liaison nurse is not part of the numbers caring for patients in the ICU, and the current bill provides nursing ratios that do not comply with the long-established standards of ACCCN and CICM.

So they did raise those concerns around the access nurse and liaison nurse, and that has been somewhat clarified in relation to the correspondence I have received from the ANMF, but I do want to spell out just the concerns of the intensive care nurses. These are the nurses actually working in the units, and this is why it was confusing for them. This is why the confusion has come about, and I do not think the government has consulted. Yes, they have consulted with the ANMF, and yes, the ANMF had a couple of members from the Victorian division of the ACCCN that they obviously spoke with, but they have not gone to these stakeholders and really understood this, hence we have got this confusion, which I think is disappointing. As this ICU nurse wrote to me:

I have worked as a nurse in Melbourne’s Level I ICUs for the past 35+ years in a variety of roles.

She also has extensive knowledge, I might add, that she said in relation to working as a representative of these statewide bodies. She went on to tell me:

… the nature of intensive care is unpredictable, with patients suddenly needing complex interventions that require more than 1 nurse to implement, and patients from other areas in the hospital requiring urgent admission to the ICU in the middle of a shift; very few patients have an ICU admission scheduled as part of their hospital stay, especially in Level I ICUs. The inclusion of an ACCESS nurse is therefore vital to provide Assistance, Coordination, Contingency, Education, Supervision and Support –

that is what it stands for –

when the workload suddenly escalates mid shift, when other staff are not available. The Team Leader is not able to manage their usual duties, assist with a deteriorating ICU patient, and provide all the care for an emergency admission from the ward until the next shift starts. This is neither fair nor safe.

The term “Liaison Nurse” is possibly misleading, with the biggest part of their role being as a member of the Medical Emergency/Rapid Response Team that provides immediate assistance to deteriorating patients outside the ICU; this includes patients who have had a cardiac/respiratory arrest. Unfortunately the number of MET/RRT calls is increasing each year, so the LN can spend most of their shift outside the ICU, regardless of the time of day/night.

All three roles of Team Leader, ACCESS nurse and Liaison Nurse are therefore required to keep ICU and ward patients safe, especially in hospitals with a Level I or II ICU. Expecting ICU nurses to consistently perform 2 roles simultaneously is unfair and unsafe for both the patients and the nurses, and will lead to poorer patient outcomes and increased nurse burn out and attrition.

That is why I read that in, because these nurses have been confused around what is possibly proposed.

In the letter to me from the ACCCN, the College of Intensive Care Medicine and ANZICS, they give a scenario of a typical level 1 ICU with 28 ICU patients and six high-dependency patients, ‘which is proposed to be staffed as per below’, comparing the ACCCN’s concerns with the bill’s ratios. They go on and say that an ICU with 28 beds at one to one with the bill would have 28 staff. A high-dependency unit at one to two – that is three staff – with the bill would have three staff. The assistance, coordination, contingency, education, supervision and support nurse at one to 10 in the ACCCN model would have three; the legislation has zero. The team leader would be one to 10 – again, the ACCCN says that three would be required; the bill allows for that. The nurse in charge would be one, and the bill says one. So they are saying that there is a potential cut from 38 staff to 35.

I did appreciate speaking with the ANMF yesterday. We went through it. They said they did think there has been some confusion, and I received a letter last night around that. They are saying that there is just a bit of confusion in the way it is interpreted. I understand that. They are saying that not everyone has the same terms and that hospitals have different titles for various roles that an ICU or high-dependency unit or a CCU might have. So I do understand what they are saying. Nevertheless it has caused this confusion, and I think that is disappointing. I do thank the ACCCN and other stakeholders for providing me with the information, because when I have reached out to these stakeholders, this is what I have got back. But I just do not know that the government has done their work. They have not gone out to the stakeholders. Again, I asked in the bill briefing, ‘Who did you consult with?’ I did not get that answer. Obviously I know that the ANMF are going to be providing the information, because they wrote to me:

On 4 November, then Premier Andrews wrote to Lisa Fitzpatrick detailing election commitments for the nursing and midwifery workforce. For Level 1 and Level 2 ICUs this was to fund an additional 160 full-time equivalent (FTE) of team leader and liaison nurse, as well as to enshrine existing practice in the legislation of 1:1 ratio for ICU patients on all shifts.

I am well aware of that election commitment, but I do have concerns around when the ANMF, in their frequently asked questions, talk about the level 2 hospitals that do not have the additional staffing on night duty. The gap in that night duty in the level 2 hospitals – there is concern around that. It is an eight-bed ICU level 2 hospital. On the am shift and the pm shift there is a liaison outreach nurse – or however it is titled – but on night duty there is no such liaison or outreach nurse or anybody else covering that area of work. So these nurses and others are saying – these specialists who work within intensive care units – there should be at least a liaison nurse to cover all shifts, and that includes night duty. What I have been trying to say is that it can be very fluid, as the nurse who wrote to me – I read out her email – explained regarding exactly what happens in an intensive care unit.

I do think, again, that this confusion could have been avoided if the government had done proper consultation with the various stakeholders that have been involved so that it could have been sorted out or at least addressed. I will be addressing those shortfalls during the committee stage of the bill.

I just want to say that I am very grateful to have spoken to a number of people around this. As I said, it was not just the ANMF; CEOs of hospitals but also nurses and others have reached out to me and been very concerned about the confusion. There was an article on this very issue in the Age, in which somebody said, yes, the government are rushing their bills so no wonder mistakes are being made. I will quote it actually:

A Labor source, speaking on the condition of anonymity because they were not authorised to speak publicly. said there have been some “stupid” mistakes recently with the drafting of bills.

I hope that is not the case with this. I hope that this confusion can be sorted out and that these concerns that have been raised with me, the minister and others can be clarified, because if there have been mistakes – if there are gaps – then let us look at them, work through them and make sure that the intent of the bill is actually there and that our hardworking intensive care nurses and those working in these areas feel supported and feel that the legislation reflects their needs. At the moment I am concerned that, with the numbers that have contacted me, they do not feel that the bill is supporting them and there is confusion in language. I do understand that; hospitals will have different titles, whether it is liaison, access, outreach or whatever it is. But there needs to be some sort of consistency in this so that this confusion does not arise.

Nevertheless, again I say there are many, many, many Victorians who are grateful for the extraordinary work that our nurses and all those clinicians do within our ICUs, emergency departments and hospitals on the whole. I do want to commend the work that they do and thank them for it on behalf of the Victorian community, because it can be extremely stressful, extremely demanding. What they go in and face every day, if you have not experienced it, can be very, very difficult at times. I want to just place on record my thanks to all of them on behalf of the Victorian community. Let us ensure that we get this right so that the intent of the bill is met, that safe patient care is actually adhered to and everybody is supported.

Sarah MANSFIELD (Western Victoria) (14:23): I rise to make a contribution on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. We understand that broadly the nursing and midwifery workforce welcomes the changes in this legislation to introduce new minimum workload arrangements in intensive care, high-dependency, coronary care and emergency settings and postnatal and antenatal wards. Supporting our health workforce is vital to ensuring that the system is operating sustainability. We know that a strong workforce means better patient outcomes and a thriving community. Ratios have existed in many parts of our hospitals for years in Victoria. It is something we should be really proud of. They ensure appropriate levels of staffing to meet demand.

I can speak firsthand as to the importance of nurses in keeping our health system running. They are really the backbone of our health system. Anyone who has ever been a patient in hospital knows this. We know that it is the nurses who are the ones who are always there; they provide the round-the-clock care. But as it stands, in many parts of our hospitals, like our maternity units, there are not legislated ratios. This risks wards being understaffed, providing fewer nurses per patient. Not only does it impact the quality and safety of patient care, but it also impacts the workload on nurses.

We already have a nursing and particularly a midwifery shortage. Ensuring that our existing workforce have a good working conditions will help to support their longevity and reduce the risk of them experiencing burnout and leaving the workforce. The bill directly addresses these issues, so the Greens will be supporting this bill.

I want to take this opportunity, however, to flag what is missing from this piece of legislation. For many years now the mental health workforce have been asking for ratios, which currently only exist in the Victorian public mental health services enterprise agreement, to be legislated, and on face value the bill before us today appears to have been the perfect opportunity to action these requests; indeed it is something that was promised by the former Premier. Yet mental health wards are exempt from ratios as per the original Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015, and there has been no attempt to amend this through this bill.

The Royal Commission into Victoria’s Mental Health System called on mental health services to move away from the medical model. This means supporting robust multidisciplinary care teams in mental health units, teams made up of mental health nurses, social workers, occupational therapists and lived-experience workers. Enacting consistent ratios across mental health services that reflect these teams would go a long way towards ensuring that mental health consumers receive continuity in the quality of their care no matter where they live. Evidence and testimony from the workforce suggest that occupational violence and aggression can be reduced in mental health settings by improving nurse–‍patient ratios. Surely improving workforce welfare should be this government’s priority, given what we know from Safe Work Australia about the high rates of workers compensation claims for nurses in mental health wards as a result of mental stress. Whilst the workforce is currently engaging in a fresh enterprise bargaining agreement negotiation with the Victorian Hospitals Industrial Association, surely taking the step to legislate these requests would go a long way to assuring the workforce that their working conditions are taken seriously. We implore the government to work in good faith with our public mental health workforce, but we, as stated, will be strongly supporting this bill today.

Sonja TERPSTRA (North-Eastern Metropolitan) (14:27): I also rise to make a contribution on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025, and I am very pleased to be doing so. As somebody who worked for the Australian Nursing and Midwifery Federation (ANMF) Victorian branch, I reflect fondly actually on how just before I came into this place as an elected representative I was very pleased and proud to lead a team of very skilled and expert nurses who then also transitioned to becoming industrial organisers and the like. I had the benefit of attending public hospitals on my run and seeing the very hardworking nurses and midwives who worked in those hospitals doing the amazing work that they do each and every day to help keep Victorians safe.

I guess what we know and understand here on the government benches is that our health system is built on the skill, dedication and compassion of Victoria’s nurses and midwives. Not only do I want to publicly thank them for the work that they do each and every day in keeping Victorians safe, but I also want to reflect on the incredible dedication and work that they undertook during the pandemic, which was one of the most stressful periods really in our history. It was a one-in-100-year pandemic, and we know that the nurses, midwives, doctors and health professionals who turned up in our public health system each and every day really went above and beyond. It is something that we need to continue to thank them for, because it was a very difficult time.

This bill really is about delivering on our election commitment that we made in 2022. If you go back to 2015, there was the first tranche, introducing nurse-to-patient ratios. The basis for introducing nurse-to-patient ratios really was because what the research showed was that when you have ratios, you have better patient outcomes as well. So this is about improving patient outcomes to make sure we are backing in our hardworking nurses and now midwives and giving them the resources that they need to ensure that they can deliver really good patient outcomes. We have listened to and we have consulted extensively with our nurses and midwives, and this is why we are introducing this new tranche of reforms – because this is what our nurses and midwives told us that they wanted. Again, this amendment bill that we are introducing now is delivering on those reforms. It is an election commitment. We are proud to have introduced these reforms in 2015 and now also proud to be delivering on these commitments.

I am going to talk a bit about what the bill does, and then I am going to turn to some of the concerns that Ms Crozier highlighted. I have also received some correspondence from the College of Intensive Care Medicine of Australia and New Zealand and the ACCC. I have read that correspondence as well; however, I will come back to that.

As I touched on earlier, the nurse-to-patient and midwife-to-patient ratios, which were first introduced in 2000, were unfortunately subject to the Liberals trying to force nurses to trade them away as part of their enterprise agreement negotiations. That is why in 2015 Victoria became the first state in Australia to enshrine the nurse- and midwife-to-patient ratios into law. These new ratios that we are debating today, which are the core of this bill, are the result of extensive consultation with nurses and midwives, the Australian Nursing and Midwifery Federation and health services. What it will do is as follows: it will provide one-to-one nurse-to-occupied bed ratios in intensive care units on all shifts for all level 1 and 2 hospitals. That means that every occupied intensive care unit bed will have a dedicated nurse assigned to it at all times. Intensive care units will also require a team leader and liaison nurse for the very first time. That is going to be enshrined in law.

I am deliberately not going to use acronyms because it drives me wild that there will be people watching at home not understanding what we are talking about when we use acronyms. Unfortunately, the healthcare system and the public service really love acronyms, but I am going to force myself to say it all in longhand so everyone at home can understand what we are actually talking about. It will improve staffing ratios in resuscitation cubicles in emergency departments on morning shifts, bringing morning shifts in line with afternoon and night shifts, and there are also one-to-four midwife–patient ratios in postnatal and antenatal wards on night shifts. Previously the ratio was one to six, so we are bringing that down to one to four. Also, there will be an in-charge nurse on night shifts in standalone high-dependency and coronary care units. This will also help to ensure that all our health services are adequately supported and prepared to action these changes, with the amendments being rolled out in a staged approach. If I recall, the original nurse-to-patient ratios, when they were brought in, also had a staged approach. Twenty-five per cent of the additional staffing will be implemented the day after royal assent, 75 per cent from 1 December 2022 and then 100 per cent from 1 July 2026. There are a variety of reasons for that. Obviously hospitals need time to get across the changes, but also I know this government and other stakeholders consistently talk about the need to recruit more nurses, because obviously it is a feminised profession but also an ageing profession, and we need to recruit more staff into it to make sure there is that pipeline of skilled and trained nurses who can work in the system.

I will just return to some of the concerns that were raised earlier. There is some confusion around whether the ratios are going to staff at the current levels or increase the current levels. Different iterations seem to say that there might be a reduction in some of those ratios. I was just talking to the advisers in the box and getting some advice on that, because I have read the correspondence that was forwarded to me, raising concerns that there might be potential unintended consequences. I note what the ANMF has said about this as well. There seems to be confusion in the terms used. There is not necessarily consistency across some hospitals in the terms or the titles that are used for some nurses. Some nursing unit stuff are referred to as either liaison or assistance, coordination, contingency, education, supervision and support nurses, and some of these titles are not consistent across hospitals. But rather than saying that there is going to be a reduction in staff, what the bill does is actually implement a floor so that if other hospitals want to have more staff, either in their emergency departments or their intensive care units, they can do that. This does not mandate anything other than the floor. They cannot go below the floor, but if they want to add additional staff to their complement of staff, then hospitals are quite able to do that.

Again on some of the responses, I understand there is confusion, but obviously when these things get rolled out there will be greater consistency as time goes along. Like I said, this is a floor. It is not taking anything away. So those hospitals who think they have a better staffing complement than the one that is being offered as a floor can maintain that complement as well.

Before I move onto our investment, I think Ms Crozier and others have also talked about occupational violence and aggression. Quite frankly, this bill is not about occupational violence and aggression, and anyone in this chamber would no doubt condemn anybody who subjects our hardworking nurses and midwives to occupational violence and aggression. I know there has been a lot of work done in the health sector about reducing occupational violence and aggression and making sure that those nurses and midwives or healthcare workers who turn up to work can do so safely. I also in my time at the ANMF visited criminal psychiatric hospitals. They are a completely different kettle of fish. They are quite different workplaces to work in. Not only are you dealing with potential medical issues, but there are psychiatric and mental health issues as well. I note that those hospitals take a range of different and other precautions around ensuring safety. Again, this bill does not really address occupational violence and aggression in the sense that what ratios are ultimately designed to do is improve patient outcomes. We know what the evidence says: by introducing these ratios we are seeing improved patient outcomes. Again, it is sort of like a distraction, I guess, that is being raised by the Greens and the Liberal opposition to say that we are not doing enough on occupational violence and aggression. I know the union not only works with the hospitals and the employers, but it works every day with their members and their health and safety representatives in those workplaces on making sure they continue to improve any reported occupational violence and aggression events if and when they occur.

On our record for investing and supporting our nurses and midwives, the government committed $101.3 million in the 2023–24 budget to support the implementation of these new ratios. This builds on our government’s 28.4 per cent pay rise that was given to nurses and midwives through the public sector agreement. I must state too for the record that it was the ANMF and its members who fought hard for that increase. Whilst it was the government who agreed to it, it was them who ran a fantastic and very successful campaign to see those increases flow through the enterprise agreement. That 28.4 per cent will help to recruit and retain more nurses so we can get the very best care for Victorians, because we know that you have got to be paid properly to turn up to work every day. Like I said at the beginning of my contribution, we thank our nurses and midwives every day for the work that they do. We know how hard they work, and we know that they keep Victorians healthy and safe every day. That is why a 28.4 per cent pay increase over the life of that four-year agreement was absolutely warranted, and I commend the union for running a successful campaign on that. As I said, that is a historic deal. What it also does is it recognises the undervaluing of a feminised profession like nursing. There are many feminised professions, but nursing is one of those. There is a historical undervaluing of nursing as a profession. The Allan Labor government also sees this as a very important step towards gender wage equity in Victoria.

In addition to the wage increase, the new agreement backs in our existing workforce and encourages a new generation of nurses and midwives by delivering preserved longstanding career structures and opportunities for career progression. It also delivers on incentivising permanent work through a new change-of-ward allowance, which will compensate nurses and midwives when they are moved from their base ward. There are also improved nightshift penalties for permanent nurses and midwives and a right-to-disconnect clause, which is also very important. We know that the Liberal opposition in Canberra want to get rid of the right to disconnect, so we are very pleased to see that enshrined in their enterprise agreement.

But improved access to flexible working arrangements recognises that nurses are available 24/7. On flexible working arrangements, I know it was something that frequently came across my desk as an in-house lawyer for the nurses and an industrial officer. Many, many nurses would request flexible working arrangements because they had young children and they also wanted to parent their children, and that was something that was incredibly tricky to deal with, so I am glad to see there is improved access to those working arrangements as well. The bill also reduces the qualifying period for parental leave from six months to zero and includes recognition of service for interstate public sector nurses and midwives who have relocated to Victoria, recognising labour mobility, which we know is so important. If we want to employ more people, they may well come from interstate, so that is a good thing.

Since we have come to government we have increased our healthcare workforce by nearly 50 per cent. That is a huge investment and recognition and acknowledgement that we need our nurses more than ever and that they deliver such important outcomes for Victoria in our health sector. That equates to an additional 40,000 nurses, midwives, doctors, allied health professionals and other hospital staff in the state’s health services. One in four of these new roles have been created in rural and regional Victoria as well, and now there are 45 per cent more nurses and midwives and 78 per cent more doctors in our hospitals than when we came to office.

The clock will beat me very soon, but I am very pleased to be speaking on this bill. I commend this bill to the house, and I again want to thank all our hardworking nurses and midwives for all the great work they do for Victorians each and every day.

Ann-Marie HERMANS (South-Eastern Metropolitan) (14:42): I also rise today to speak on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025, and may I start by saying how much the coalition does appreciate our medical profession and our nurses and the great work that they do for our community. For a number of people right now, they are serving away in hospitals and working very hard. I myself have had to grace hospitals over the years and have been very appreciative of the care of so many of our nurses. I do take issue with the colleague across the chamber mentioning that it is a very feminine profession. I do not agree with that. I do think that there are many male nurses and they do a fantastic job, and they are not necessarily feminine in any way. Some of them are fathers and some of them are football players, and they do a fantastic job. They often do some of the heavy lifting. I do appreciate nurses regardless of their gender and appreciate the hard work that they give this community. It is a profession which we are most grateful for, and we recognise that nurses work hard for the money which they earn.

Having said that, I had to visit a hospital only yesterday. It was actually the ICU of a well-known public hospital, and I was incredibly impressed with, first of all, how many ICU units you can actually fit into a space and how well attended patients were with the care of nurses. I do not know all of the terminology for nursing, but there were definitely not just the nurses that were in the ICU unit with that particular patient but also those that were coming in and were offering additional support and suggestions. I was impressed at that time by how many nurses could actually be attending to the care of one patient at any one time. Having said that, I am not personally opposed to us providing the care that we require for our patients, and the nurses I know do an incredibly hard job. It is a hard job to do if you do not have the staffing and the support that you need, and we do want nurses to have the staffing and the support that they need. This bill is an attempt to improve that, and I applaud the bill’s requirements and its intent.

I do, however, have to note – and I did not feel that it was adequately addressed – that there are some stakeholders that have been writing in that have some concerns about the bill, and they include the Australian College of Critical Care Nurses and the College of Intensive Care Medicine of Australia and New Zealand.

I find it interesting that these stakeholders were not adequately consulted in the finalisation of this bill. I think that they actually have some important information that could have been relayed had those who were constructing this amendment been willing to engage with wider stakeholders. I would like to quote from something that they have been circulating where they address some of the issues and concerns that they have. They say this:

Many nurse unit managers of intensive care units in Victoria have been in contact with us to express their confusion over the intent and language used in the proposed legislation …

Their concerns … the potential detrimental impact on staffing resources and, ultimately, safe patient care. Of note, many have highlighted the discrepancy between the ratios in the proposed legislation and the industry standards …

of the Australian College of Critical Care Nursing, ACCCN, and the College of Intensive Care Medicine, CICM.

They go on to provide information and make suggestions where they talk about the assistance, coordination, contingency, education, supervision and support nurse. They say that the ICU liaison nurse is not part of the numbers caring for patients in the ICU; that the current bill provides nursing ratios that do not comply with the long-established standards of ACCCN and CICM; and that if this is implemented as proposed, it will threaten the safety and wellbeing of patients and staff in these hospitals with ICUs. To maintain patient safety and dynamic staffing capability, standards specify the ACCESS nurses – and ‘ACCESS’ refers to assistance, coordination and contingency for late admission on a shift or staff who are sick mid-shift, education of less experienced staff relative to others, and supervision and support to the primary bedside nurses in the ICU – essentially act as a readily available resource to manage patient admissions, staff shortages and complex situations while also supporting less experienced nurses in the unit. They are essentially a float nurse with a higher level of expertise specifically dedicated to the ICU environment. They maintain that having the ACCESS nurse could have been an addition – and this is not my professional background, so I do not have the same opportunity that some of those who have been speaking in the house today might maintain. But they make the following recommendation, with minimal changes to the wording of the bill to facilitate ease of discussion: the majority of level 1 and level 2 hospital ICUs in Victoria and Australia with critically ill patients could have this ACCESS nurse alongside the team leader. I just wanted to put that out there.

As I said, this is not my professional background. It does bother me that perhaps all the stakeholders were not actually consulted. I think that it is important, when engaging in something like this, to make sure that we do take the time to do wide consultation, because this is not simply about having a union win of having staffing ratios for patient care. This is not what this should be about. This should be about actual patient care and also looking at the way a hospital is run. The last thing I want to see is great nurses, excess nurses, not actually being adequately utilised in our hospital system, which of course is under financial constraints as it is. I am going to have a dig here at something that has nothing to do with nursing, but it really bothers me when I go past construction sites and I see four people sitting around eating, two people standing around watching people work, one person actually in a machine, one person holding a sign, one person watching the person who is holding the sign and watching the person who is in the machine. I just wonder what the heck we are doing with our costs when we have so many people standing around watching people work when the people who are doing the work are actually not getting enough support. I would hate to see that in a hospital situation, because really we cannot afford it. Whilst it would be lovely to have people being able to sit around and watch people work and get paid for it – and maybe getting paid more than those who are actually doing the work – the reality is we need everyone to be pulling their weight when we are in state that is in so much debt.

I say that because in terms of funding the government has allocated $101.3 million to implement the increased staffing levels; however, it has not been able to provide the detail of this allocation in the budget papers. That is a concern to me, and I am sure it would be a concern to many Victorians as well. We know that health services are under enormous financial strain. Several hospitals are currently operating at a deficit as of last year and are struggling to pay their staff and are struggling to pay their bills on time. What is unclear here is whether the allocated funding will be sufficient to meet the higher costs of employing more casual agency nurses if hospitals are not able to recruit permanent staff. The other issue here is that given the financial pressures throughout Victoria’s health system, the new nursing ratios could lead to further budget constraints elsewhere, such as planned surgery capacity.

These are some of the concerns that we need to think about in terms of where these nurses are going to come from. I realise that surgical nurses do not do the work in ICU and they do not do the work in midwifery, but the point is if you are going to have nurses you have got to have them from somewhere, and if you are going to have an increase in nursing in particular areas then it means that we have to have these nurses coming from different places. And some nurses are trained in a variety of areas and do move around within the system, and so these are going to be pressures that we need to think about. I am not convinced that the modelling has been done. I understand that it has been left to health services to review their own operational capacity, but that is going to be a concern perhaps for those who are in the private system. I am not sure how this is going to work when we actually have the issue in hospitals, and it is going to take time for this to be implemented in a way that is effective.

Having said that, as I say, I really appreciate the work that nurses do. I do want us to have staff-to-patient ratios that are fair and reasonable and that work. I am not from this profession, but I want the very best for the people who do work in this profession as well as for those who are patients in the care of nurses. But I want it to be fair and I want it to be reasonable and I want it to be operational. I want it to work in such a way that we do not have a few people doing a lot of work and then a number of people standing around not doing an awful lot at all. That is a concern, because there have been times – and I am not saying that this bill does it – when things have been put in place that have actually made it so difficult for hospitals to operate within their budgets, and while there is a tremendous need for nurses to be supported in certain areas in hospital work, there are some areas where there are genuine concerns that there could be an overload. I am not saying that this is what this does, but I am just saying that we do not really know how this is going to work out. I hope it works out the way it is intended. I hope it is not just an exercise to allow some to work well and others not to. But I do say that whilst we have concerns in terms of how this is going to put pressure on the health system, we have not taken the position of opposing the bill.

We do wish our hospitals and our nursing staff all the very best, and once again I do want to reiterate how much we appreciate the work that they do, how professional they are and the ongoing professional development that they undertake. I was so impressed with what I witnessed yesterday in the ICU and the way they collaborated together and were able to listen to each other and check things. There was one nurse that was clearly in a role where they were coming through and double-checking what others were doing and able to offer that additional support, and I thought it was incredibly good. It was during the day, and I realise that at night-time it is a different situation; I am just saying I want it to be a fair and reasonable thing. And I think it is something that if we are going to put it in legislation would warrant the opportunity for review, not because you want to have people not having the wages that they deserve or the role that they deserve but simply to make sure that we implement something that is fair and reasonable and that works for all Victorians and all Victorian hospitals.

David ETTERSHANK (Western Metropolitan) (14:55): Legalise Cannabis Victoria welcomes the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025, which, as the title suggests, introduces further improvements to nurse-to-patient ratios in hospitals, plus improves staffing ratios for midwives in postnatal and antenatal wards. Specifically, the bill introduces one-to-one nurse-to-patient ratios in intensive care units so that a nurse will be assigned to every occupied bed in the ICU, and it also introduces an ICU team leader/liaison nurse position. Secondly, the improved staffing ratios on morning shift in resuscitation cubicles in emergency departments are captured, bringing them in line with the afternoon and night shift provisions. It introduces a one-to-four midwife-to-patient ratio in postnatal and antenatal wards for night shifts, and it also introduces an in-charge nurse for standalone high-dependency units and coronary care units during night shifts. The reforms have the backings of the Australian Nursing and Midwifery Federation (ANMF), and these improved ratios are a credit to the union and its members and are the product of a very long, long process of advocacy and negotiation by the union and its members. The reforms will support the safety, health and wellbeing of Victoria’s nurses and midwives, which of course in turn will lead to better outcomes for the patients who are in their care.

I do note, as have a number of speakers, that we recently received correspondence from the Australian College of Critical Care Nurses, who the ANMF have worked closely with on these ratios since I believe 2021. The ACCCN are requesting an additional assistance, coordination, contingency, education, supervision and support nursing position for intensive care units to be included in the bill, as well as additional ICU liaison nurse positions. Their concerns, however, do seem to focus on the nomenclature of these ACCESS nursing roles. We have discussed this with the ANMF, and their understanding is that the bill provides for both liaison nurses and team leaders. These team leaders are basically the ACCESS nursing positions according to the ACCCN’s workforce standards definition. Given the extensive mapping undertaken by the ANMF in relation to this bill, they are confident that these roles are clearly delineated and that the ratios are appropriate and satisfactory.

I will just make two other points at this stage. One is that of course we need to remember that these ratios are minimums. They are not a cap; they are not designed to contain. They are operational minimum safety nets that should apply in the setting. So concerns about who is covered and not should I think perhaps be seen in that context. Secondly, I would just like to take umbrage with where I think Mrs Hermans was going in terms of a fear, or a perceived fear, that these changes might see nurses standing around. I do not know how much time Mrs Hermans has spent in an ICU at night or a CCU, but I can tell you that they are not standing around; they are not waiting for things to happen. These are positions that require skill, energy and dedication. These are high-pressure jobs, and it concerns me that there might be this implied suggestion or smear that these ratios represent an excuse for nurses to stand around. I just want to object most profusely to that imputation from Mrs Hermans.

These ratios were an election commitment by the Andrews government in 2022. While it is gratifying to see the government honour that pledge to our dedicated and hardworking nurses and midwives, it does bring to mind another group of equally dedicated and hardworking health professionals who are still waiting for the election commitments made to them to be honoured.

Back in 2018 the Labor government committed to enshrining mental health staffing profiles in bed-based services as per the 2016 mental health nurses enterprise agreement. Anyone paying attention to the public mental health enterprise bargaining agreement negotiations would know that this commitment has subsequently been, to put it politely, shelved by the government. The mental health sector is generally treated as a poor relation to the health sector, and its workers are not afforded the same entitlements and protections as other health workers – and I use the word ‘protections’ intentionally. These health workers are the very backbone of the mental health system, but they are subject to unworkable conditions, dangerous understaffing and increasing levels of occupational violence and aggression in the course of their work. A core reason is the lack of any staffing ratios for workers. It is no wonder that the mental health sector cannot retain its highly qualified and dedicated staff.

For too long government has relied on the goodwill of its mental health workforce to prop up the system. We simply cannot sacrifice the wellbeing of our mental health workers, particularly at a time when our suicide rate is double the road toll, we are in the midst of a youth mental health crisis and there is ever growing anxiety due to cost-of-living pressures. We simply must start to invest in our mental health workforce at this critical time. We call on the government to introduce staffing profiles for mental health workers in all bed-based units and community teams. That said, we commend the bill to the chamber.

Jacinta ERMACORA (Western Victoria) (15:01): I am pleased to speak on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. Like many of my colleagues across this chamber, I would like to take this opportunity to thank our dedicated health workers for their hard work and care in delivering world-class health care across our state. Demand for health care is at record levels, and the importance of the roles of nurses and midwives is obvious to everyone needing to be hospitalised. Indeed they also provide care out in our communities.

Nurses bring their whole selves to work. It is largely a part of the care component that is provided that is all about the human being and the interpersonal connection with patients and their families and the advocacy that is transacted between nurses and the broader health system or hospital that they are in. It is a unique and really important role. It has always seemed logical to me to introduce nurse-to-patient ratios for those being cared for and for the carers in hospitals, both for better care and also for a better workplace.

Nurse-to-patient ratios are directly related to patient safety, and lower ratios mean nurses and midwives have more time to provide individualised care, reducing the risk of errors, complications and adverse events. Adequate staffing allows nurses and midwives to provide higher quality care, including better monitoring, more thorough assessments and improved communication with patients and their families. Reasonable workloads reduce burnout, stress and fatigue among healthcare professionals, leading to better job satisfaction and staff retention. Ultimately the ratios help ensure that public health funds are used effectively to provide adequate staffing levels.

They were introduced by the Bracks Labor government in the year 2000, and despite this the former Liberal government tried to force nurses to trade them away as part of their enterprise agreement negotiations. This is a really important thing to note, because there is a stark difference between Labor support for health care and healthcare workers and the Liberals and the coalition.

That is why in 2015, under a Labor government, Victoria became the first state in Australia to enshrine nurse- and-midwife-to-patient ratios in law. Later the COVID pandemic caused unprecedented demands on our health system and showed further how the work of our nurses and midwives is fundamentally critical to the success of our health system and also, importantly, to the provision of life-saving health care, particularly during COVID. We all saw the markings on nurses’ faces after a day fully covered in less-than-comfortable masks to prevent themselves from catching COVID. Those health professionals, not just nurses but allied health staff and doctors as well, had to put up with that all the way through COVID. Even though it can be somewhat planned for, a pandemic is by its very nature overwhelming and unexpected.

I am sure that everyone in this room has experienced care from a nurse, either by being vaccinated or COVID-tested or – hopefully not – hospitalised. Indeed anybody who was born most likely experienced the care of a nurse in the first moments of their life, focusing on their health in those first precious moments of breathing and the start of their lives. Obviously that nurse care was provided by a midwife. It is really all the way through our lives that we interact with nurses. When we hear stories of people who have been in hospital – whether it is at the start of their lives, the middle of their lives or the end – there is always a thankyou and an expression of appreciation for the care that nurses and midwives provide in what is often the most stressful moment in people’s lives when it comes to their health. A significant portion of the work undertaken by nurses and midwives is with people that are very stressed or family members that are very stressed. The other element that I want to acknowledge today is the scientific, medical and technical knowledge that nurses and midwives have that they bring to their role, which takes years of study, training and ongoing study as well. That along with their own personal style and communication techniques are the two really important ingredients for an awesome nurse or midwife.

Given that we have all experienced nursing care and midwife care, we did in the 2022 election commit to further protecting and strengthening nurse-to-patient ratios. We committed to this because it was our nurses and midwives that gave us the feedback to let us know that this is what they needed. With this bill we are delivering on those commitments. A number of my colleagues in the chamber have also gone through the particular changes. I will quickly run through them, just to reiterate. The new ratios are the result of extensive consultation with nurses and midwives, the Australian Nursing and Midwifery Federation (ANMF) and health services and will set in stone a number of changes: one-to-one nurse-to-occupied-bed ratios in ICUs on all shifts for all level 1 and 2 hospitals, meaning that every occupied ICU bed has a dedicated nurse assigned to it at all times; ICUs requiring a team leader and a liaison nurse for the very first time – there have been several descriptions of what those roles involve; and improved staffing ratios in resuscitation cubicles in emergency departments on morning shifts.

This will bring morning shifts in line with afternoon and night shifts. These changes will also provide a one-to-four midwife-to-patient ratio in postnatal and antenatal wards on night shift – that is an improvement from one to six – and an in-charge nurse on night shifts in standalone high-dependency units and coronary care units.

I know these changes are being welcomed by hospitals across our state. The Warrnambool Base Hospital is a level 2 hospital, and South West Healthcare is welcoming these changes. Matt Watson, an organiser of the ANMF based in Warrnambool, has also expressed his support for these changes on behalf of his members in that union. These changes will now be rolled out in a staged approach to ensure staff will be supported and prepared for the increase in services. As has been identified by colleagues in the chamber already, 25 per cent of the additional staffing will be implemented straightaway, 75 per cent by 1 December this year and 100 per cent from 1 July 2026. To this end the government committed $101.3 million in the 2023–24 budget to support the implementation of these new ratios. The new ratios build on the Labor government’s 28.4 per cent pay increase for our hardworking nurses and midwives, helping to retain and recruit more nurses so more Victorians can get the very best of care.

I am very proud that this bill also recognises the historic undervaluing of highly feminised workforces. I know my colleague Ms Terpstra referred to this. Certainly, whilst we have had recent progress in encouraging males to take up nursing, the occupation still suffers from the burden of being under-recognised and underappreciated for the scientific, medical and technical knowledge required and also for the care that is provided. As we all know, historically, work performed by women tied to traditional gender roles that relegated women to domestic and caring duties has often been seen as less valuable than work performed by men. These roles, even when translated into paid employment such as nursing and midwifery – there are other occupations that have the same issues – have carried the stigma of women’s work historically, and I have always found it unfair and frustrating that to this day women continue to work for lower wages and less recognition. We know this from the reporting that happens federally now through changes in the federal government in that area. That is how we know this, so thank goodness we have got reporting on that. Particularly, many feminised professions involve care work, which requires significant emotional labour, interpersonal skills and responsibility. These skills are often overlooked or dismissed as natural abilities rather than recognised as both valuable and demanding skills.

The undervaluation of feminised work is a major contributor to the persistent gender pay gap. Lower wages for women translate to economic inequality, impacting their financial security, retirement savings and overall wellbeing, so I do feel very that it is very important to acknowledge that this new enterprise bargaining agreement (EBA) that was recently signed backs our existing workforce and encourages a new generation of nurses and midwives. It preserves longstanding career structures and opportunities for progression, and this creates succession planning opportunities and exciting career challenges and milestones, encouraging people to thrive in their workplace.

It incentivises permanent work through a new change of ward allowance, which will compensate nurses and midwives when they are moved from their base ward. It improves night shift penalties for permanent nurses and midwives, because there is a price for working while others are asleep. It includes a ‘right to disconnect’ clause, which was also mentioned by Ms Terpstra. It improves access to flexible working arrangements, recognising that nurses are available 24/7. It reduces the qualifying period for parental leave from six months to zero – what a difference that will make – and it recognises services for interstate public sector nurses and midwives who have relocated to Victoria.

Since we came to government we have grown our healthcare workforce by nearly 50 per cent. That is an additional 40,000 nurses, midwives, doctors, allied health professionals and other hospital staff in the state’s health services. Almost one in four of these new roles have been created in rural and regional Victoria, an appropriate allocation of resources. There are now 45 per cent more nurses and midwives and 78 per cent more doctors in our hospitals than there were when we came to office.

In closing I want to say that not just this bill but also our support of EBA arrangements are really important commitments from the Allan Labor government, and I commend this bill to the house.

Renee HEATH (Eastern Victoria) (15:17): I rise today to speak on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. I want to start by saying our healthcare workers are heroes. They play a vital role in our state. They face the work that they turn up to every day with incredible courage, compassion and humour, and they are working in a very overwhelmed and broken system. This bill at its core is about patient safety and the working conditions of our frontline healthcare workers. Its aim is clear: to mandate safer minimum staffing levels across Victorian hospitals. The government says that this will improve the safety and quality of patient care in Victoria as well as workload arrangements for our nurses and our midwives. It builds on the 2022 election commitment developed in partnership with the Australian Nursing and Midwifery Federation, an organisation that has made it no secret that it is unashamedly a political movement. The government wants to expand on nurse- and midwife-to-patient ratios across ICUs, emergency departments and maternity wards, particularly during night shifts. It promises better care, fairer workloads and time for hospitals to adjust. Its phased implementation requires 25 per cent compliance at its commencement, 75 per cent by December of this year and full compliance by July 2026.

On the surface, who could object to better nursing staff levels? But in reality, especially for rural and regional Victoria, it is far more complex, and in many cases it is far more concerning. The member for South-West Coast Roma Britnell, our colleague in the other place, rightly pointed out that Victoria is already facing a severe shortage of nurses, particularly in specialised areas like intensive care and midwifery. She warned that these new ratios may exacerbate the issue by placing additional strain on an already overburdened system. She asked: how will rural communities comply? Many already lack the resources to recruit and retain qualified nurses. Mandating new ratios could force these facilities to divert resources from other critical areas, reducing patient care instead of improving it.

Britnell also raised that there could be unintended consequences: hospital closures, reduced services and increased risk to patients. She made clear that without a significant increase in funding for recruitment, training and infrastructure this bill’s objectives may remain unattainable. I think she raised some very good concerns there.

The member for Sandringham, our colleague in the other place Brad Rowswell, was scathing, really, in some of his remarks. He questioned the feasibility of a phased implementation, calling it an aggressive recruitment drive that simply is not possible given current workplace limitations. He asked where the money is coming from and, more importantly, where the nurses are coming from. These questions the government could not answer. He raised serious efficiency concerns, pointing to the possibility that rigid ratios could force hospitals to redeploy staff from other areas, which actually could leave some units worse off. These are very important issues to consider.

And then there are the experts. The Australian College of Critical Care Nurses, the College of Intensive Care Medicine of Australia and New Zealand and the Australian and New Zealand Intensive Care Society are professionals we trust to guide our most critical care policies. They warn of what they say are patient safety risks and unsustainable workloads. They say combining ICU liaison nurses with assistance, coordination, contingency, education, supervision and support nurses into one undefined role would ‘make these critical functions less effective’. They stress that liaisons and support roles are each full-time tasks that cannot be attended by one person simultaneously. They fear that this legislation could actually reduce intensive care nursing numbers, not increase them. Let me repeat that: the law intended to boost ICU care might actually be shrinking the staffing levels.

These concerns are real; they are not just theoretical. In March last year – and we have spoken about this many times in this place – the Herald Sun revealed that three babies died in just six weeks at Latrobe Regional Hospital. Whistleblowers told the press that several staff involved were never interviewed for a review. This government then refused calls for an independent review of safety protocols, and now they want us to trust them with rigid mandatory staffing reforms. These failings do not exist in isolation; they are part of a broader pattern of a government that overpromises and underdelivers – it is something that it has been extremely consistent in – and a government that is now shackled to the very union interest that helped put it in power. After a decade of deal making with the CFMEU, firefighters, police and health unions this government has backed itself into a corner. It cannot afford the promises it has made, and now the chickens have come home to roost. They are crushing private investment, they have driven business out of Victoria, they have pummelled business and they are shrinking the tax base that could have funded essential services, and we do not have a lot to show for it. We have got a healthcare system that is, sadly, buckling under pressure; we have nurses – incredible people – that are burnt out and overworked; we have got ambulances that are ramped; we have got patients that are waiting hours to see a doctor – and often this has detrimental consequences; and we have got hospitals that are drowning in red tape and deficit.

We have also got to consider the realities for regional Victoria, particularly for my area of Eastern Victoria Region and Gippsland. Hospitals in these regions face lower preprocedure funding. They receive $782 less for a knee reconstruction and $1744 less for a hip replacement than Melbourne hospitals. These numbers are not minor; they represent an 18 per cent gap in funding that punishes regional areas like Bairnsdale. Cash flow is dire. In the 2023–24 report the Bairnsdale Regional Health Service had just four days of cash on hand. Forty-four Victorian health services reported a combined loss of $906 million in one year.

Hospitals are being told to break even by mid-2025, and how are they going to do that? They have got to do that by cutting back hospital beds, slashing frontline staff and cancelling planned surgeries. In Pakenham, locals are still waiting for the hospital, the community hospital that was promised in 2018. The government committed to 10; only five have begun construction, and none of them are in Eastern Victoria region. These funding gaps make mandatory ratios not just unrealistic but dangerous. If regional hospitals can meet these new laws, they will not be safer; they will be forced to close wards and to turn away patients. Meanwhile, nurses are burnt out. In Bendigo, 50 per cent of hospital staff say they plan to leave within two years due to workloads. Regional hospitals are overrun, underfunded and undervalued. And let us not ignore the elephant in the room, which is violence in hospitals. The Herald Sun reported that every 13 hours a healthcare worker faces violence or armed threats. There were more than 680 code black incidents in just one year in Melbourne hospitals alone. Hospitals cannot afford PSOs, let alone extra nurses, and yet the government expects them to stretch their budgets even further still.

Finally, I want to talk about another aspect, which is the housing crisis in regional areas, which is really strangling recruitment. In Gippsland affordable rental and housing has dropped by nearly 50 per cent in just one year. Some hospitals need 150 rental properties just to house staff, but they cannot afford to build them and they cannot afford to buy them. Petrol prices and cost-of-living pressures hit rural nurses the hardest, with many driving long distances, and if the numbers do not stack up, they simply have to leave.

There is also a community aspect to this. Community support really matters. Nurses need to feel like they belong. They play such an incredible, vital role that takes every part of them, and they need to make sure that they are part of a community where they belong and where they are supported and encouraged. But if their partners cannot find jobs and if their kids cannot get into school, they move on. Colleagues in roles like this become like family in these places, and when everyone is burning out even those ties are temporary. So I will be clear: we all want better nursing and midwife staffing. We all want that. We all want safer hospitals and stronger care. But this bill – this rigid, top-down, union-driven piece of legislation – ignores some of the facts on the ground. It ignores the staffing shortage, the cash crisis, the rural discrepancies and the basic infrastructure failures that plague our healthcare system. It ignores the experts, it ignores the tragedies, and it ignores the realities of regional Victoria. If the government truly wants to improve patient care, it must fund services properly, it must consult genuinely, and it must support flexible, achievable solutions that work for every community, not just the ones within the tram tracks.

Ryan BATCHELOR (Southern Metropolitan) (15:29): I am pleased to rise to speak on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025, which does a range of very important things, including introducing staffing ratios into intensive care units, improving staffing ratios in resus cubicles in emergency departments on morning shifts, improving staffing ratios in postnatal and antenatal wards on night shifts in prescribed health services, introducing an in-charge nurse team leader and liaison nurse in addition to prescribed ratios and shifts in level 1 and 2 ICUs, improving staffing ratios in high-dependency units and coronary care units by introducing additional in-charge nurses on night shifts and standalone HDUs and CCUs and making some other further minor amendments.

Quality health care is built on the foundation of a well-supported and well-resourced workforce. There is no more important part of ensuring our patients get the care that they need than having highly qualified, well-trained and well-supported healthcare professionals to do that caring and do that treatment, and nurses and midwives work tirelessly as the backbone of our healthcare system. We thank all of our healthcare workers, but we thank particularly our nurses and our midwives for the work that they do day in, day out. We know that as the backbone of our healthcare system nurses and midwives need our support, and Labor has stood side by side with our nurses constantly to make sure that they have got the human resources that they need to do the caring that they need to do and the other resources as well.

On nurse-to-patient ratios, it was the Bracks Labor government in the 2000s that introduced the first nurse-to-patient ratios in this state, before the Andrews Labor government, after the 2014 election, made the significant and groundbreaking move of enshrining those ratios in law. The Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 was the first of its kind in Australia, and just as with so many other features of our federation, Victoria led the way on nurse-to-patient ratios, and our colleagues around the country have been following suit ever since. It was this Victorian Labor government in 2022 that introduced the undergraduate nursing and midwifery scholarship program, offering free tuition grants for people to study nursing or midwifery in 2022 and 2023. This bill is yet another example of how Labor is backing our nurses and our healthcare workforce so that they can continue to provide the high-quality care in our hospitals, in our healthcare settings, that Victorians absolutely deserve.

We know that there have been incredibly tough times in our healthcare system in recent years. That is why we have got to do all that we can to continue to support the healthcare professionals, particularly the nurses, providing our care, to make sure that the working conditions that they are working in and they are working under are supportive. This bill that is with us today and the actions that this government has taken day in, day out since we were first elected in 2014 demonstrate Labor’s commitment to supporting nurses in our healthcare system with enshrined in law nurse-to-patient ratios, more support on training, more support on scholarships, more resources and better pay. That is what Labor does. Nurse-to-patient ratios are a critical part of that, and their importance to the system cannot be overstated. It is about more than just a piece of legislation; it is about more than just numbers on a page. It is about making sure that there are enough nurses in the stations, in the wards, to deliver the vital care and monitoring and support their patients and enough midwives delivering post- and antenatal care, ensuring that ICU patients are able to receive the critical care that they need. Improved staff ratios, better patient care – it is a pretty simple equation. This bill builds on the work of Labor governments past. It builds upon the legislation that we brought into the Parliament that put nurse-to-patient ratios in law in 2015. That original bill made great strides for our nurses. We know that the work of good policy reform is never done. This bill takes those reforms an important step further.

Some of the key elements of the bill include a one-to-one nurse-to-occupied-bed ratio on ICU units on all shifts in level 1 and level 2 hospitals. This will ensure that every occupied bed in those ICUs has a nurse that is always assigned to it. We will have one-to-four midwife-to-patient ratios in postnatal and antenatal wards on night shift, down from the previous one to six.

It will improve staffing ratios in resuscitation cubicles in emergency departments on morning shifts, bringing them into line with afternoon and night shifts. There is no good reason why they should be different. What this legislation does is align those ratios of morning, afternoon and night shifts in the resus cubicles in emergency departments. The legislation also introduces an in-charge nurse, a team leader resource nurse and a liaison nurse in ICUs, which will serve to provide additional support to not only patients but also their families and the rest of the hospital staff. These changes will help to ensure that our nurses and midwives can deliver the highest standard of care with the time, resourcing, staffing and support they need to do their jobs safely and effectively. Our overall goal is to improve patient care and ease the burden on the system.

To ensure that the implementation of these changes is a success they are being done in a phased way to enable adequate planning and preparation. Twenty-five per cent of the additional staffing will be implemented on the day after royal assent and 75 per cent from 1 December 2025, with full implementation from 1 July next year. We are putting together an implementation plan that will ensure that we can deliver and ensure that there is enough time for the system to get ready and enough time to do the necessary training, rostering and the like.

We do know the importance of enshrining in legislation nurse-to-patient ratios here in Victoria. We have seen other jurisdictions follow suit – as I mentioned, in Queensland in 2016. They have also demonstrated in those jurisdictions that there have been significant positive results overall for their healthcare system. There have been several peer-reviewed studies of the changes to nurse-to-patient ratios that have been undertaken in that jurisdiction, and that has demonstrated improvements in both patient and staff outcomes, including reductions in mortality, reductions in readmissions and better infection control. The studies have shown that the legislating of nurse-to-patient ratios in that jurisdiction has helped to retain nurses in the workforce by reducing burnout and improving overall job satisfaction.

The work that has been done in the bill to improve nurse-to-patient ratios builds upon the investment that this government have been making since we were first elected to invest what is required in our healthcare system. Not only are we legislating but we are putting resources behind the change to make sure their implementation is successful. There was $101.3 million committed in the 2024–25 state budget to support workforce initiatives across our healthcare system, including funding to boost nursing workforce capacity. We have made significant investments to support people to undertake studying nursing – so free nursing and midwifery courses here in Victoria. We have gone through a phase of that, which is assisting the next generation of healthcare professionals by ensuring they have got the opportunity to train and enter the workforce without financial barriers.

Since coming to government, the healthcare workforce has grown by nearly 50 per cent. That is 40,000 more nurses, midwives, doctors and allied health professionals in our healthcare system here in Victoria, more healthcare workers working in our healthcare system – a significant increase. That is what investing in our healthcare system delivers. It delivers more people who can help Victorians get the health care that they need. That is in addition to the extra people we have put into the system and the extra resources we have provided to enable the recruitment of those extra nurses, doctors and other healthcare professionals. That is in addition to the significant pay that we have put on the table, the significant 28.4 per cent pay increase delivered to our hardworking nurses and midwives in the most recent enterprise bargaining round, helping to retain and recruit more staff so that Victorians can get the care they deserve. We have also improved night shift penalties and improved parental leave provisions and flexible working arrangements to support the existing workforce.

This government has shown again and again and again that we support our healthcare workforce, we support our nurses, and we are willing to put both the resources and the pay offer on the table and bring the legislation through the Parliament to recruit more nurses and to make sure they are paid properly and also to put in law – which is what this bill does – the ratios to ensure that high-quality patient care is maintained.

We know that the investments that we are making in our healthcare workforce, particularly the support that we are providing to our nurses, are a critical part of ensuring that Victoria has the health care that we need. We also know that the choices that Victorians have when they come to the ballot box will be informed by our record and also by the record of those who seek to form an alternative government. I think on this matter it is pretty clear that when it comes to backing in our nurses, Labor has always been there supporting them, whether that is through better pay, increased resources or legislating nurse-to-patient ratios. The same cannot be said for those who also seek to govern this state. We know that the Liberal Party has had a lot of difficulty supporting legislation in this Parliament to enshrine nurse-to-patient ratios in law. We know they have had difficulty in doing that because they seemingly do not have the sort of commitment to this issue that they should. They have been unwilling in the past to support that legislation, and we are not going to let them stand in the way of delivering better outcomes for our nurses. We are not going to let them stand in the way of pay deals that deliver higher pay to our nurses, which is what Labor has been delivering. We are not going to let them stand in the way of increased resourcing of workforce initiatives that are supporting more nurses to become trained in this state. That is what Labor has been delivering.

We know there is a constant challenge in ensuring that our healthcare system has both the human resources and the physical resources that it needs to stay a cutting-edge place of high-quality healthcare. You only need to look around the skylines of Frankston and Footscray to see the investments that this Labor government is making in building more hospitals – the Frankston Hospital coming on at pace, the Footscray Hospital coming on at pace. When they are both completed, those two projects – just to take two – are exactly the kind of investments that Labor makes in our healthcare system.

We will absolutely continue to support our healthcare workforce at the same time we increase the physical capacity, our healthcare infrastructure. This legislation makes important steps in improving the legislative framework to support better nurse-to-patient ratios in Victoria. It is an important part of Labor’s legacy of supporting health care in the state. We introduced it for the first time in the 2000s. We legislated for the first time in 2014 with the 2015 act. This bill expands the legislated framework for nurse-to-patient ratios here in Victoria, and I commend the bill to the house.

Melina BATH (Eastern Victoria) (15:44): I have been listening intently to the debate, and it is quite a wideranging debate. There is some fact in there, and we have heard some folly and some falsities from those opposite just now –

David Davis interjected.

Melina BATH: and, as Mr Davis just said, some hyperbole into the bargain. We do not want to play politics with health care or the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. I was listening to my colleague and our lead speaker, Ms Crozier, who is certainly well informed in this space, being a nurse herself, but also being very much available, interested and with a finger on the pulse of our health system, as much as you can be from opposition. She does a very fine job of it, and I thank her for the work, on behalf of the Liberals and Nationals, on the scrutiny of government and being an ear and being accessible to those in the health system that need to ventilate their concerns about the government and what it is doing and what it is not doing in our healthcare system.

Indeed this bill seeks to improve patient care and safety, and that should be the primary focus, concern and motivation of all healthcare legislation coming through this place. We have heard this before, but I just want to put it on record: it makes changes to existing ratio requirements for level 1 and level 2 hospitals; level 1 and level 2 ICUs are to be at a one-to-one ratio; in level 1 hospitals and level 2 ICUs new requirements are introduced to have team leaders or ICU liaison nurses and a nurse in charge of the unit; it looks to have a one-to-one nurse-to-patient ratio for each resuscitation cubicle in an emergency department on the morning shift, which is currently at one to three, and also a one-to-four ratio for midwives in postnatal and antenatal wards on night shift – currently that is that at one to six; and also, finally, it requires in-charge nurses on night shift in standalone high-dependency units and coronary care units. I am just putting on record some of the main provisions in the bill. We have also heard the government is going to commit a tad over $100 million into implementing these increasing staffing levels, but it has certainly not been able, in discussions and questions by the Liberals and Nationals, to give any detail of this allocation in the budget papers.

We do know that our health system is under enormous strain; you do not have to be sitting on a mountain and contemplating this to see it. Day to day in our electorate offices we have constituents who come in and lament the lack of services or, particularly in rural Victoria, the waitlist to access services or sometimes, very unfortunately, the lack of good service in a system under pressure. No-one likes talking about that, and I am not going to stay and dwell on it too much. But clearly there are system pressures in regional Victoria, there are staffing allocations that are frequently a challenge to meet and there are hospitals where services are being trimmed and cut. We have seen certainly that hospitals have been challenged in relation to meeting the current and existing ratios as they stand in regional Victoria.

The Liberals and Nationals will not be opposing this bill. We support its intent to improve safety and achieve better health outcomes for patients but also of course take some of that stress and strain off our nursing fraternity and enable them to do their jobs with more focus, more capacity and more time allocated to each individual patient. Clearly in this case that is critical care that needs that urgent attention and monitoring around the clock. As Ms Crozier has spoken about, it is certainly concerning how the government is going to fill these rosters with the requirement for new nursing staff across Victoria. Indeed some of that will potentially come from backfilling with casuals. What are the cost implications on our hospitals in relation to covering those costs for the casual work pool?

I was having a little read while listening to debate on this of the report Nursing Supply and Demand Study 2023–25. This is right across our nation, not just in Victoria. There are examples and illustrations around how our nursing supply is not actually keeping up with demand. Our population is growing. Our need for community health care – and not only community but hospital and intensive care – is growing. We are an ageing population of course and all of us humans and our body parts require specialised nursing, and it seems to me from this report that we are not keeping up.

Indeed the report did say, and I concur, in relation to female staff that it is overwhelmingly a female-based workforce, the nursing workforce, of 88 per cent across the nation – I am sure that is quite similarly reflected in Victoria – and 12 per cent males. And if I can put a comment out on this one, it is that my own son happens to be a nurse, and not only is he a nurse, he is a nurse in intensive care. He has worked in emergency departments, he has a masters degree and he has worked in paediatric intensive care units, and of course PICU is a very significant and specialised area of paediatric intensive care. He has been on the floor in those units, where he is looking after either one very delicate and prem baby – and paediatrics can mean up to 18 years old – but also up to teenagers with head injuries from accidents and the like. They really do watch every breath that that patient takes, and I just want to pay homage to and thank our nursing fraternity for having those skills, that patience, that commitment and that love of those people or children who are in their care for that time. And I am sure they take it home too. I am sure they worry about their patients as well, and I am sure even though they feel regularly burnt out they make it their utmost concern and care to make it to the next shift where and when they can. And without giving any further confidences away, I am also very much aware of when both doctors and nurses are trying to fill staffing allocations for wards and can be in a long and draining and quite intensive position themselves, because there is a time factor and a need factor to fill those rosters.

One of the things that we also note is the importance of our sectors and, in relation to our training, both our universities, for registered nurses and bachelor degrees, but also our diploma courses, for our enrolled nurses with the work that they do to backfill some of those more intensive roles in our healthcare system. And again, some of my colleagues – I note Dr Heath – certainly raised it about the workforce in regional Victoria.

It is interesting when you read in the papers that post COVID many of our agencies – and by that I mean government departments – have decided and the government is saying, that you can work from home. I often reflect on the fact that nurses cannot work from home, they have to be on the floor. Doctors cannot work from home. Victoria Police cannot work from home no matter how tired they are; they often backfill and come in even though they are overworked and exhausted. And also of course there are our teachers – although they were forced to work from home during COVID. But their normal habitat is certainly in front of a class of noisy and demanding children with varying degrees of understanding. So those are our really frontline services – ICU, EDs and the like – for our nurses.

What I just want to finish off with is: we do need to have a focus. This government must have a focus to keep up with that demand. I get concerned that our sectors, both our universities in regional Victoria and our TAFEs, also need staff to provide that workforce education ongoingly, and I know that there are examples where that is not always the case; they struggle. So it is a whole-of-system requirement. And this government is very good at spruiking their credentials, but we see the pressure points certainly in regional Victoria. And if we look at some of these hospitals, we are talking about level 1 hospitals in Victoria and level 2. Many of our regions actually of course feed into those level 1 hospitals, and there are 14 of them on my count. And in relation to our level 2 hospitals we know Latrobe Regional Hospital is in that category, and again, it has a wide catchment in Gippsland. It always brings me no joy to talk about some of those pressures that it is under. It is all very well and good to build new buildings, but to staff them, to furnish them and to have the funds to be able to continue to pay for them and to pay for those staff are ongoing challenges.

Indeed it will not be a shock to people from my electorate to understand some of the concerns that people have had in relation to Latrobe Regional Hospital and the fentanyl issues that I am sure they are working on, but the government needs to give full focus and full support – and the same with Safer Care Victoria. It has to pay that full eye, mind and resolve to improve patient outcomes into the future.

Finally, I want to make some comments in relation to what are called local health service networks. We in the regions know, and Ms Crozier certainly knows, that that is code for hospital mergers. We have heard in regional Victoria and in my electorate the discussion around the Bayside mergers. That seems to me to be code for concern that, if you have got a major hospital in the Alfred, the government is going to supply it with far more funds and direction, the lion’s share of that funding, if there is, we will say, a merger, a Bayside merger – and it looks like there will be – as opposed to those smaller hospitals at Leongatha and the like. It will just end up being the case that local hands on the boards are removed, and we are going to see a stripping away of local jobs and a stripping away of the ability to prioritise the unique needs of those regional communities. I think this is quite a heavy-handed approach. Of course it is always seems to be done by this government without that detailed conversation and consultation. Many of the boards are probably required or requested to have a positive slant on it, and I can understand that, but at the end of the day the Nationals and the Liberals are concerned about that service delivery.

We do not oppose this bill. I am pleased that Ms Crozier will investigate or interrogate her concerns on behalf of the Nationals and the Liberals, but this bill certainly can pass through this house.

John BERGER (Southern Metropolitan) (15:57): I rise to speak on the bill to amend the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 relating to nurse-to-patient and midwife-to-patient ratios. I thank the Minister for Health, Minister Thomas in the other place, for all the hard work that she has done in that role, a cornerstone of this government’s reform agenda, because we know that Labor built Medicare and only Labor governments will strengthen and protect Medicare. On a state level that means we will always put a focus on the healthcare system.

It was under the Andrews Labor government back in 2015 –

Georgie Crozier: On a point of order, Acting President, I know that Mr Berger is desperate for a political hit on a federal election campaign, but this is about safe patient care and ratios, and I would ask you to bring him back to the bill that we are discussing today, not being a smartypants and having a go at the federal coalition. It is pathetic.

Lee Tarlamis: On the point of order, Acting President, it is a wideranging debate. I have been listening, and it has strayed somewhat.

The ACTING PRESIDENT (Jeff Bourman): Mr Berger has only just started. We will let him continue on, but let us keep it to the bill at hand.

John BERGER: It was under the Andrews Labor government back in 2015 that Victoria became the first state in Australia to enshrine the nurse-to-patient and midwife-to-patient ratios into law. It was a landmark reform which improved the quality of care afforded to patients and improved the working conditions of thousands of nurses and midwives. We have demonstrated our commitment to strengthening nurse-to-patient and midwife-to-patient ratios ever since.

In 2018 we committed to strengthening these ratios through legislation and the improvements that have now all been phased in and implemented across Victoria. Fairer ratios between nurses and midwives and patients lead to less strain on our health services and a safer environment for patients. That is why the Andrews and Allan Labor governments spearheaded an agenda to provide not just for a fairer work environment but for a safer one. From there came Australia’s first nurse-to-patient ratio and midwife-to-patient ratio system from a state authority. It will continue to stand as one of the most critical reforms to our health system, and now the Allan Labor government is building on that legacy by introducing safe nurse-to-patient ratios.

We have been building up our health system towards a one-to-one ratio between patients and nurses, and this is now what this bill aims to achieve. Under the new amendments outlined in this bill, there will be a new ratio standard set in level 1 and level 2 hospitals. This will set out a parity of one to one between nurses and occupied hospital beds. That means that for every patient in ICU at these hospitals there will be a dedicated nurse at all times of the day. But it is more than that. The changes also include a new organising team leader of these nurses as well as a liaison nurse, and together they can manage a group of nurses dedicated to patient care around the clock. For midwives the ratio now will be one to four in postnatal wards. It means that for every four patients there will be at least one midwife around the clock as a standard. That is an increase from the current ratio of six patients for every midwife. These new staffing arrangements will be introduced gradually, in stages. Twenty-five per cent of the new staffing will be introduced immediately after the royal assent, and that will be gradually increased up to 75 per cent by the end of the year. This bill provides total compliance by mid next year. This staged introduction provides enough time and flexibility for hospital management to meet these targets.

The Allan Labor government in Victoria and in fact all Labor governments are the governments that people turn to protect their healthcare system. The lessons of this state are clear: if we want a strong, resilient health system, it means we have to treat our healthcare staff with dignity. Working in a hospital requires years and years of education. It is a big achievement, but it comes with frequent exposure to a highly stressful environment and long-term stresses. In the end, it costs a lot of money to study to become a doctor, a nurse, a midwife or any other medical professional in a hospital. Students in medicine do not go through years and years of an extensive and stressful education just to hang up the coat after a few years of practising. They learn it because that is what they are passionate about, and it is up to the government of the day to ensure hospitals have the resources to retain that workforce. Doctors, nurses and midwives will not stay in the healthcare system if they are subjected to poor pay conditions for more hard work. It is why the Allan Labor government supported a 28.4 per cent pay rise for our hardworking nurses and midwives. Nurses and midwives work around the clock to make sure all patients are looked after, and they deserve a pay rise. But more needs to be done if we want more nurses and midwives staying in hospitals to look after more patients.

If we want to ensure our health services remain world leading, we need to also look at how we can improve the quality of care. We can do this by ensuring adequate staffing levels. This will provide the quality of care needed and the care that patients deserve. It is all about having a safe and resilient work environment, where these workers are not stretched thin and can look after patients properly. This can be the difference between someone receiving the critical care they need or not. Without a healthy nurse-to-patient ratio, each healthcare worker will be stretched thin looking after more and more patients. Hospitals need enough staff to manage critical patients around the clock and to make sure nurses and midwives are not further overworked and eventually burn out. Having a more equal ratio of nurses and midwives to patients is how we ensure that this does not happen. Currently there are around four patients to every nurse during the morning and afternoon shifts at hospitals. On the night shift it becomes around one to six. That means that for every four people in the ICU there will be at least one attending nurse ensuring everything is all right during the day, and of course at night the ratio is closer to one to six. I can speak to the importance of the state Labor government’s move to introduce these ratios in the first place. There is a clear need for us to now step up our efforts more. This is a landmark reform that we are very proud of, and that is why the Allan Labor government will always try to strengthen nurse-to-patient ratios. We know how important the healthcare system is.

Since coming into office, we have grown our state’s hospital workforce by approximately 40,000 new staff. Having a better funded workforce, better staffed hospitals and fairer and safer nurse-to-patient ratios have been the foundations of our reforms. This has helped ease the pressure on our health system. I will note that in the last quarter alone there were around 504,000 presentations to emergency departments in Victoria, but despite the demand and pressure on our emergency services, the average time it takes to help patients is now 14 minutes, an improvement of 8 minutes from before the pandemic. That is a direct result of our efforts to strengthen our health services despite growing demand.

I said earlier that a well-functioning health system must look out for patients as well as staff. This amendment will have a direct and positive impact for those under intensive care in hospitals. When the new ratio for nurses and midwives to patients comes into full effect, patients and their loved ones will have the assurance that someone is always there looking after them.

It is important that with these new ratios we support hospitals in our health system the whole way, including hiring and recruiting new staff, particularly nurses and midwives. Stronger ratios are an excellent way of improving patient care and reducing stuff burnout, but to make it work it means we need more nurses. That is why the Allan Labor government has supported and will continue to grow programs which have boosted the numbers of our nurses in Victoria. It was this government that introduced free TAFE here in Victoria. One of the many free TAFE courses is of course the diploma of nursing. In total, not just from this diploma, each year around 3000 students graduate from nursing and midwifery courses in Victoria. That means more and more nurses and midwives are finding their way into hospitals with these new ratios, allowing for more around-the-clock care for critical patients. That is a good deal for patients and it is a good deal for the new nurses.

We have also allocated in the budget around $101.3 million to support the implementation of new ratios. This is a fund that will take some of the burden off the hospitals and the broader health system when it comes to hiring new staff, helping ensure a smoother growth and transition to the new arrangement. One of the places this may have the biggest impact is in regional and rural Victoria. Of the 40,000 new doctors, nurses and midwives brought on since the Andrews Labor government came into power, nearly one in four were situated out in regional and rural Victoria. That means there are more trained professionals and medical staff in our regional cities and towns. That 40,000 also accounted for a nearly 50 per cent growth of our health workforce in just 10 years. There are now 45 per cent more nurses and midwives and around 78 per cent more doctors since we came into government. Our on-road paramedic workforce has also increased by about 50 per cent since we came into government, with around 2200 more paramedics. Last year alone our workforce grew by around 6.7 per cent in the health sector. This is a result of the Labor government’s investment into our hospitals and into our health workers as well.

Victorians will always look to us to fund our health system, because they know we are the only ones who will back them in, both health workers and patients in hospitals. This government has invested millions into programs to help boost the uptake of nursing in tertiary education and to boost wages to help retain the workforce. We have delivered training and recruitment programs, including $270 million for the initiative to make it free to study nursing and midwifery. This goes towards building the supply of nurses and midwives available to the hospitals to hire. It also increases the capacity and the quality of the nursing and midwifery workforce, allowing health professionals to treat and care for more patients. Even better for the results, with a 50 per cent growth in the workforce, a quarter of those are in regional Victorian, and with about a 28.4 per cent pay increase in the last round alone, the Allan Labor government is investing in a more resilient and stronger health service for Victorians. The 2024–25 budget invested a further $183 million in workforce initiatives, including investing an extra $28 million to support our health services and boost our nursing workforce capacity.

We are also building up our health sector’s capability through infrastructure. We are investing an additional $1.5 billion, on top of more than $8.8 billion invested in the state budget. That brings our health funding up to more than $20 billion and more than 25 per cent of Victoria’s entire budget expenditure. That is because Labor cares about our health system, and Labor will always strengthen it. Our system only works if we continue to grow its capacity and invest in its future. Strengthening the ratio of nurses and midwives to patients is a critical element in that. You can see the results directly in the figures. When you consider the investments made in our health infrastructure and the investments made to improve wages and conditions for nurses and midwives, you can see the impact of stronger ratios.

Victorians’ average life expectancy is higher than any other jurisdiction except the ACT and is among the highest anywhere the world. Victoria has the lowest infant mortality rate anywhere in the world. We are also ahead of the other states in the elective surgery waitlist turnover rate. Victoria was also the only jurisdiction that treated all category 1 planned surgery patients within clinically recommended timeframes this past year. This does not just happen overnight; it is because the Allan Labor government is committed to building up our health services and has invested in their growth.

We can see now how resilient and effective our health system is. Introducing these new ratios will be the next step in levelling up our health sector so Victorians can continue to get the treatment they deserve. Having one nurse available at all times of the day will improve the quality and care afforded to all patients. That is what this legislation is about. Patients rightly expect quality and timely care from the health system they pay taxes to. With more nurses available through the training programs, hospitals can meet the new ratios swiftly, supported by a $101 million fund to help recruit and hire new nurses. By legislating these new ratios the Allan Labor government is enshrining its commitment to our health system and to the health workers. It gives patients assurance that the staff will be available to care for them around the clock. It gives healthcare workers the support they need, with more staff sharing the workload without stretching their capabilities thin, and it gives patients the care they expect and deserve in hospitals.

To wrap up, Victoria continues to innovate and lead the way nationally when it comes to our healthcare system, from the 41 per cent survival rate in cardiac arrests, the highest in Australia, to Ambulance Victoria’s free GoodSAM app making a difference, with more than 17,000 registered respondents and 793 cases attended by volunteers, to the 250 kids’ lives that have been transformed by liver transplants, a milestone we celebrated just last week, to making it easier to seek help for opioid dependence closer to home, to of course, the more than half a million calls that have been made to Australia’s first virtual emergency department. I am proud of the work that we continue to do in the healthcare space. This bill builds on the Allan Labor government’s record of health and goes a long way to further strengthening our health services. I commend the bill to the house.

David DAVIS (Southern Metropolitan) (16:12): I am pleased to make a contribution on this bill, which is about safer patient care, and I compliment Ms Crozier on the work that she has done in understanding the actual impacts of the bill. It is very clear that in a number of areas it will have an effect that will confound the objectives. The intensive care areas in particular, as Ms Crozier highlighted, will actually be put under greater pressure with this particular approach, and the government has not thought through staffing and not thought through the actual problems that are involved with this bill. So often with these sorts of bills you do need to understand that even while you may have good intentions, there can be a range of outcomes that are not thought through and can actually lead to perverse and unintended consequences, and this is such a bill. The thought has not been there, and in fact without the proper staffing coming through, without the support, it is going to be very difficult to deliver for the community.

Frankly, our health community is under real pressure, and the quality of health care is deteriorating. Even today I have heard on the radio commentary about the declining bulk-billing rates in Chisholm, in part of my area and in Ms Crozier’s area, and we have seen the bulk-billing rate fall from about 90 per cent under the last government down to 80 per cent and even less under this government. That is at the community level – a fall in the bulk-billing rate. And what has Carina Garland done about it? Absolutely nothing. She has sat on her hands and allowed this to drift by. If you think of the other hospitals in my area and Ms Crozier’s area, the Alfred is under real pressure and Box Hill is under real pressure. They service many in our area, and those intensive care issues are real.

But just as important as the intensive care are the patients coming into the hospitals. Many of them do go into intensive care, but not all of them. Some of them wait and languish a very long time in the emergency department or indeed, even worse, are not able to get into the emergency department or into the intensive care – the scenes where they actually need the support that they would legitimately and medically need.

It is interesting to look at the figures and see how the problem of ambulance transfers is now manifesting, with a clinical guideline of 40 minutes. As of 30 June 2024 Monash Medical Centre, also servicing vast areas of my electorate and Ms Crozier’s electorate, achieved just 42.09 per cent, while Box Hill Hospital achieved 42.8 per cent of transfers within the 40-minute time. Now, it should be up around 90 per cent of those transfers within that time, so you have actually got hospitals under real stress, under real pressure, and patients who are languishing in an ambulance or in some cases in the emergency department. I was listening to the lower house question time this morning and hearing the terrible story from Mildura, the Mildura base hospital, and the long wait that a particular patient suffered – you know, really a very severe length of time left languishing on a gurney in that hospital.

Indeed people would be very concerned to hear these sorts of cases, and there are a number of those that come to Ms Crozier and me in our area, but what I would say in the case of Monash – it is our largest health service; it is a very important health service – for it to only be able to achieve 42.09 per cent at 30 June is a deterioration. When we were in government the last 30 June figure in our time in government was 702 patients on the elective surgery waiting list at Monash; that has blown out, to 30 June 2024, to 1038. That is up 48 per cent under Labor – 48 per cent up under Labor at Monash Medical Centre. The Box Hill Hospital went from 1800 at 30 June 2014 under us – the last full-year figures under our government – up to 2445 at 30 June 2024; that is a 36 per cent increase under Labor. So what you see is declining performance in the emergency departments and declining performance in ambulance and elective surgery elsewhere as well.

Now, the government is putting more pressure – piling more pressure – onto our hospitals with some of these various changes without understanding the full consequences and without dealing with the basics in many cases, and I think that is an important point. I know that in the areas in the east of my electorate and Ms Crozier’s electorate we have seen the bulk-billing rate fall under Labor over the last three years – a massive fall under Labor and a fall under state Labor too, but federal Labor has seen that fall. I know that Carina Garland has done absolutely nothing to deal with this issue – nothing at all. She has sat on her hands and allowed the deterioration. Why has she allowed the deterioration in ambulance performance? Why has she allowed the deterioration in the waiting list? Why has she allowed the deterioration in the bulk-billing rate in the Chisholm area? That is the question that Carina Garland that needs to answer. I say that this government, the Labor government in Victoria, has been a terrible government in the performance that it has delivered to our hospitals.

I know that at a federal level both parties have committed to large packages to support Medicare, which are broadly supported across the community. I know that there is one significant difference – that the mental health support that is being offered by the coalition is very significantly better, with an additional 10 treatments under the –

John Berger: I doubt it.

David DAVIS: Well, it is, actually; it was there in the system, and it was cut by the current federal government in a cruel and harsh cut. What did Carina Garland say about that cut in that circumstance?

Lee Tarlamis: On a point of order, Acting President, I seem to recall a point of order from Ms Crozier saying that this was a bill about Victoria, not about the federal elections, so on relevance I would ask that the member be brought back to it.

David Davis: On the point of order, Acting President, we are talking about changes in our health system for safer patient care, and I think that is very important. At the same time I am talking about examples in my electorate that relate to safer patient care. It is not safer to let people languish in a –

The ACTING PRESIDENT (Jeff Bourman): Order! We do not have to debate. I will ask you to keep it to the state. We did have one of your own people bring that up as a point of order, so if we could keep this based to a state-based conversation, that would be great.

David DAVIS: In my electorate of Southern Metropolitan there are a number of major hospitals. The Alfred has been mentioned. The government has not refurbished the Alfred as it should have – that was our policy at the last election – and the pressure at the Alfred is enormous. Again, if you want safer patient care, you have got to have modern facilities, updated facilities and facilities that are able to cope with the pressure of what comes through. The same is true with the examples I have quoted about Monash Medical Centre. The elective surgery waiting list was 702 when we lost government – at the last 30 June before we left government – and it has gone up to 1038 at the last 30 June under Labor, under Daniel Andrews and Jacinta Allan. These are state hospitals run by the state government, and the performance is terrible. Up 48 per cent under Labor – that is what has happened. Let us talk about those state hospitals and their state performance and whether it is safer to make people wait longer for their elective surgery. I say it is not safer for people to wait for their elective surgery.

At Box Hill Hospital – I might say a hospital I have some special interest in, a hospital that I oversaw the construction of and oversaw the opening –

Members interjecting.

David DAVIS: I did. I actually was there and opened it. I was there.

The ACTING PRESIDENT (Jeff Bourman): Order! We do not need to yell at each other. This is a fairly non-controversial bill. Can we just move on, please.

David DAVIS: In an effort to get safer patient care we upscaled the Labor proposal, which was a piddling proposal. It was not adequate, and we upscaled it and built a bigger hospital.

John Berger: You did nothing.

David DAVIS: We did so. We went and announced it in 2010, we built it, and we opened it in 2014. I am just telling you that is what happened. Let me tell you what the waiting list at Box Hill Hospital was on 30 June 2014. It was 1800 people.

Tom McIntosh: On a point of order, Acting President, I have been pulled up numerous times for pointing, and I endeavour not to point. I think Mr Davis should take that point on himself.

The ACTING PRESIDENT (Jeff Bourman): I did not actually see it, but I would just remind everyone that pointing is unruly and we will not have unruly in this chamber.

David DAVIS: I am being provoked, Acting President, but I should resist it. Let me just say that by 30 June 2024 – so the last 30 June, the last full-year figures – Box Hill Hospital had 2445 waiting on the elective surgery waiting list. That was up 36 per cent under Labor – the poor performance under Labor – and I say that it is not safer for people to be forced to wait. On the ambulance figures, let me be clear about those. At Box Hill Hospital the ambulance figures were 42.8 per cent of people transferred within the 40-minute benchmark, the clinical guideline. I have got to say, as much as I think the paramedics are great people and doing a very good job, it is not the safest place in the ambulance, waiting and waiting and waiting and waiting to get into the emergency department. That is not how things should be done. That is a government that has failed and that is a government that is not safer.

At Monash Medical Centre only 42.09 per cent of ambulance patients were transferred within the clinical guideline. The rest of them – nearly 60 per cent – were not transferred within the safe clinical guideline. So that is the failure of this government. If you want to talk about safety, I say you have got to go and look at the actual figures across the system. I have done a bit of work quite quickly to look at the figures in my electorate, in my area, and I say the government’s health performance has deteriorated. People are not safer, people are not getting better service, people are actually suffering and being forced to wait and wait and wait.

In the case of bulk-billing, the bulk-billing rate has collapsed in Chisholm. It has fallen. It has gone from 90 down to 80 under Carina Garland in the recent period. Let us be quite clear. What has the federal member done about it? Nothing.

Members interjecting.

The ACTING PRESIDENT (Jeff Bourman): Order! Please, some modicum of order would be fabulous. Can we stop yelling at each other. Mr Davis to continue.

David DAVIS: I will try to contain myself from the provocations, Acting President. But let me just be clear here: Ms Crozier has done very good work on this bill to understand what is going on. It is clear that a number of the government bureaucrats have not understood what is going on and the minister has not understood what is going on. The minister is out of touch. The minister has, in many respects, lost the plot on these points. The minister needs to understand what is happening with the intensive care groups. She should listen to the professionals and the specialists, and she should not dismiss the specialists and the professionals. The professionals and the specialists should be who the minister listens to.

It is not a good thing if the minister is dismissing them without paying due heed to the warnings that they have given. I say Ms Crozier has done a very good job in getting that material into the public domain, and I think that there are a lot of questions for the minister and the government to answer. In terms of my own electorate, the deterioration in the performance of the health system is shocking, and people should be very angry about that performance – and, I should say, those federal members who roam around should take responsibility for the bulk-billing rate, which has fallen under their watch.

Tom McINTOSH (Eastern Victoria) (16:26): I am glad we were spared another minute of that performance. That was a performance of the highest degree. I am pleased to rise to make a contribution on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. Labor knows our health system is built on the skill, dedication and compassion of Victoria’s nurses and midwives, and we know this was particularly true during the pandemic, when our nurses and midwives worked incredibly hard to keep Victorians safe while responding to unprecedented demands on our health system. That is why at the 2022 election the Labor government committed to further protecting and strengthening ratios. We committed to this because it is what our nurses and midwives told us to do; it is what they wanted. With this bill we are delivering on those commitments. Our healthcare workers know only Labor has their backs. Our health workforce know that only Labor listens to and implements their ideas. We are proudly the party of nurse-to-patient ratios.

Nurse-to-patient and midwife-to-patient ratios were first introduced in 2000, but the former Liberal government tried to force nurses to trade them away as part of their enterprise agreement negotiations. Mr Davis talked a lot about history over there, but we did not hear him referring to that. That is why in 2015 under a Labor government Victoria became the first state in Australia to enshrine nurse- and midwife-to-patient ratios in law. Now the Allan Labor government is building on this by introducing stronger and safer nurse- and midwife-to-patient ratios, ensuring the very best care for Victorian patients and their families.

The new ratios are the result of extensive consultation with nurses and midwives, the Australian Nursing and Midwifery Federation and health services and will be set in stone, with one-to-one nurse-to-occupied-bed ratios in ICUs on all shifts for all level 1 and 2 hospitals, meaning that every occupied ICU bed has a dedicated nurse assigned to it at all times. ICUs will also require a team leader and liaison nurse for the very first time. Improved staffing ratios in resuscitation cubicles in EDs on morning shifts bring morning shifts in line with afternoon and night shifts, and there will be one-to-four midwife-to-patient ratios in postnatal and antenatal wards on night shifts, down from one to six. There will be an in-charge nurse on night shifts in standalone high-dependency units and coronary care units. To ensure health services are adequately supported and prepared to action these changes, the amendments will be rolled out in a staged approach, with 25 per cent of the additional staffing implemented the day after royal assent, 75 per cent from 1 December 2025 and 100 per cent from 1 July 2026.

It was only last week I was out with some of our first responders, our ambos, out at Yarram and also at Paynesville. I was saying to them how incredibly respected they are in our community. Our workers in our healthcare services do incredible work. I made the joke that as politicians we want to stand beside people that glow and reflect well on us, and that is standing next to nurses, to paramedics, to people doing incredible work, saving lives and helping people at times when they absolutely need that support. I myself was in a situation where somebody passed out about a year ago and we had to call an ambulance. It was a pretty traumatic time, but the paramedics turned up and gave such great care with such calmness, and we see the same in hospitals with our nurses.

I mentioned ICUs before. I have had friends and family in ICUs over the years. There is incredible work that is done when people are at a time – not only the patients but their loved ones, friends and family – when there is such physical trauma but also that mental load on everyone going through that situation. That is why Victorians absolutely love, respect and cherish so many of those working in our healthcare system, indeed the people for whom this legislation is here to support – the people who support us.

We know that it is this side that will continue to support and invest in our dedicated health workforce because we know how important they are. That is why we are absolutely committed to delivering world-class care for all Victorians. The government committed $101.3 million in the 2023–24 budget to support the implementation of these new ratios. The new ratios build on the Labor government’s 28.4 per cent pay increase for our hardworking nurses and midwives, helping to retain and recruit more nurses so more Victorians can get the very best care. We know the Liberals’ economic policies are actually to drive wages down. They do not have many things they believe in, but one of the few things that the Liberals on the other side believe in is driving down the wages of Victorians. I am proud to be in a party and I am proud to be in a government whose position is to lift the economic wellbeing of Victorians, particularly our incredible health workforce.

Through this historic deal we are also recognising the historic undervaluing of this highly feminised workforce, an important step towards gender wage equality in Victoria. In addition to the wage increases, the new agreement backs our existing workforce and encourages a new generation of nurses and midwives by delivering preserved longstanding career structures and opportunities for progression; incentives for permanent work through a new change of ward allowance, which will compensate nurses and midwives when they are moved from their base ward; improved night shift penalties for permanent nurses and midwives; a right-to-disconnect clause; improved access to flexible working arrangements, recognising that nurses are available 24/7; a reduced qualifying period for parental leave from six months to zero; and recognition of service for interstate public sector nurses and midwives who have relocated to Victoria.

We are recognising the type of work and the hours of work that our nurses and midwives do, as I said before, at times that are traumatic for families and loved ones of someone who needs these services, whether it is someone entering the health system in an emergency or someone looking to deliver a baby, and to have the support and care of incredible staff it is only fitting that we pass this legislation and pass on the reward for the work and incredible care that they give so many of us and our broader Victorian community.

Since we came to government we have grown our healthcare workforce by nearly 50 per cent. That is an additional 40,000 nurses, midwives, doctors, allied health professionals and other hospital staff in the state’s health service. Almost one in four of these new roles have been created in rural and regional Victoria. There are now 45 per cent more nurses and midwives and 78 per cent more doctors in our hospitals than when we came to office. Growing up in regional Victoria, I can sure tell you that people have long memories of what the Liberals did when they were in government. Not only were infrastructure and services cut throughout the regions, but hospitals were closed or privatised, and I will come back to that a little bit later in my contribution if I do get time.

Last year saw the biggest yearly growth in Victoria’s history, with our workforce growing 6.7 per cent in one year. Our on-road paramedic workforce has also increased by over 50 per cent, with 2200 more paramedics on our roads since we came to government. The Allan Labor government continues to invest in the people delivering critical life-saving health services to the Victorian community and to support initiatives that help to train, attract and retain staff. This includes sign-on bonuses and supports to train and upskill nurses and midwives, making it free to study nursing and midwifery; providing speech pathology grants; and delivering Australia’s first paramedic practitioners, which was a piece of legislation that all of us on this side were very proud to stand to speak to earlier this year.

We have also delivered training and recruitment programs, including the $270 million Making it Free to Study Nursing and Midwifery initiative, to build the supply, capacity and quality of the nursing and midwifery workforce. Of course we know those opposite mock the fact that we are making it free to study, and we know that those opposite historically have slashed TAFE and will do the same given any opportunity.

The 2024–25 state budget invested a further $183 million in workforce initiatives. This includes investing an extra $28 million to support our health services and boost our nursing workforce capacity, including continuing our successful registered undergraduate student of nursing or midwifery positions. Year on year we have continued to increase funding to our health services. The Allan Labor government is investing record funding into Victoria’s world-class public health system. This includes an uplift in the price we pay all hospitals for the care they deliver. We are investing an additional $1.5 billion on top of the more than $8.8 billion invested in this year’s budget, bringing our health funding up to more than $20 billion, more than 25 per cent of Victoria’s entire budget expenditure. This is on top of the $15 billion in funded health infrastructure projects that are under construction or on the way. We will always support our hospitals, because that is what Labor does.

I have touched on the incredible work that our world-class healthcare workforce delivers for Victorians, and there are so many people that are so incredibly grateful. When we take measures like those that we have implemented in government, the public are so incredibly supportive and back us at the polls on that. Victorians’ average life expectancy is higher than all other jurisdictions except for the ACT and amongst the highest anywhere in the world. Victoria has amongst the lowest infant mortality rates of anywhere in the world, and Victoria is ahead of all other states in its elective surgery waitlist turnover rate and was the only jurisdiction that treated all category 1 planned surgery patients within clinically recommended timeframes. Victoria is ahead of the national average for cardiac arrest survival rates, and we have some of the quickest ambulance response times. I think you can see that continued investment in our health system and you can see values that underpin policies that are implemented year in, year out.

We know that the Liberals cannot be trusted with the healthcare workforce. We know that the Liberals cannot be trusted with healthcare infrastructure because they will sell the infrastructure, they will privatise it and they will cut the workforce. We know that if, God forbid, they got their hands on the lever, they would cut, cut, cut, because it is not in their political DNA to respect the public workforces that Victorians care for and depend on so much.

Our healthcare workers at our emergency departments are facing unprecedented demand, with more than 504,000 presentations to emergency departments in the last quarter alone, but thanks to the hard work of our healthcare workforce and the Allan Labor government’s investment to back them in, the median time to treat is now 14 minutes, 8 minutes faster than prepandemic. Crucially, all category 1 patients – those assessed as being critically unwell – continue to be seen immediately upon arrival to an ED. Our $1.5 billion COVID catch-up plan to boost surgical activity across the state has worked. Investments to drive down planned surgery waitlists are helping our healthcare workforce deliver more surgery than ever before, and 23 patients support units, two new public surgical centres and 10 rapid access hubs continue to deliver impressive results. Waitlists have decreased almost 10 per cent compared to the same time last year, and the number of Victorians waiting for planned surgery is now at its lowest level since the pandemic began. Almost 50,000 patients underwent planned surgery in the last quarter, and all category 1 patients were treated within the recommended time, while the median time for category 2, semiurgent, and category 3, non-urgent, patients has improved by four and 31 days respectively compared to the same time in 2024. Eighty-six per cent of planned surgery patients are treated in the recommended time.

Contrast the Labor government’s record of achievement and listening to and working with our healthcare workers with that of the Liberals and the Nationals, and the difference could not be starker. We all remember the Liberal and National parties’ secret plan to cut hundreds of nurses and get rid of nurse-to-patient ratios when they were last in government. Remember when they tried to undercut ratios to save $104 million when negotiating with our hardworking nurses and midwives? Remember when the then health minister – who was making a lot of noise over there before but has left the chamber – had his department draw up contingency plans to replace the thousands of nurses who were concerned they would have to resign because they could not safely care for patients? When last in government the Liberals and Nationals also went to war with our paramedics for two years, attacking our paramedics and running a smear campaign against them.

I mentioned it before, and before my time finishes I just want people to remember how those opposite closed Eildon, Koroit, Mortlake, Murtoa, Red Cliffs, Macarthur, Clunes, Beeac, Birregurra, Lismore, Elmore and Waranga. It is all in their history. What we have achieved is on the record and has been delivered, and I stand to support this bill.

Sheena WATT (Northern Metropolitan) (16:41): I am pleased to rise and make a contribution on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. The Allan Labor government continues to lead the way in ensuring that every Victorian receives world-class health care built upon our unwavering dedication and the expertise of our nurses and our midwives. We recognise that without a strong, supported workforce our hospitals and healthcare system would not be able to deliver the level of care that Victorians need and absolutely deserve. This bill is another example of Labor’s commitment to backing our healthcare workers by strengthening and protecting nurse-to-patient ratios. Labor understands that safe staffing levels are not just about numbers on a page, they are about patient outcomes, patient safety and the wellbeing of those who need care and those who provide it.

With this bill before us we are delivering on our promise to nurses, midwives and patients by enshrining in law stronger, safer staffing ratios, ensuring that healthcare workers can do their jobs effectively without being overstretched and overworked. Nurse-to-patient and midwife-to-patient ratios were first introduced by a Labor government in 2000. Since then our commitment to improving these ratios has never wavered. It was a Labor government that enshrined these ratios in law in 2015, making Victoria the first state in Australia to do so. This is of course a perfect opportunity to honour the minister who led that important work, so can I acknowledge former health minister Jill Hennessy for the amazing work she did in protecting our healthcare workers. At the time I was working in health, and I remember it quite fondly.

Once again, importantly, it is worth noting that the Allan Labor government is taking this commitment further with a bill that will introduce even stronger staffing ratios across key areas of our health system. These new ratios are the product of thorough consultation with nurses, midwives, the Australian Nursing and Midwifery Federation – ANMF – and health services. They include critical changes, such as ensuring a one-to-one nurse-to-occupied-bed ratio in intensive care units – ICUs – on all shifts for all level 1 and level 2 hospitals, guaranteeing that every ICU bed has a dedicated nurse assigned at all times. They include improved staffing in emergency department resuscitation cubicles during morning shifts, bringing them in line with afternoon and night shifts. There is also a reduction in midwife-to-patient ratios in postnatal and antenatal wards on night shifts, from one to six to one to four. There is a requirement for an in-charge nurse on night shifts in standalone high-dependency units and coronary care units. Also, to ensure that the health services can implement these changes, importantly, the amendments will be introduced in a staged approach, with 25 per cent of the additional staffing implemented the day after royal assent, 75 per cent by 1 December this year and full implementation by 1 July 2026.

This builds upon the Allan Labor government’s continued investment in our health workforce. We understand that quality patient care relies on a well-supported workforce.

That is why we have backed our nurses and midwives with a $100.3 million commitment in the 2023–24 budget to support the implementation of these ratios. Our government has also ensured that Victorian nurses and midwives are paid fairly and are valued. We delivered a historic 28.4 per cent increase for nurses and midwives, recognising the historic undervaluing of this really highly feminised workforce. This wage increase is part of our broader efforts to drive gender wage equity across Victoria. Alongside these wage increases we have taken action to support our existing workforce and encourage new nurses and midwives to enter the profession. Our latest enterprise agreement includes the preservation of longstanding career structures and opportunities for progression. It includes incentives for permanent work, including a change-of-ward allowance to compensate nurses and midwives moved from their base ward. It includes improved night shift penalties for permanent staff and a right-to-disconnect clause, allowing healthcare workers to properly switch off outside of work hours. It includes improved access to flexible work arrangements, recognising the 24/7 demands of the profession. Some that I am particularly pleased to see are the elimination of a qualifying period for parental leave, reducing it from six months to zero, and recognition of interstate public sector nurses’ and midwives’ service when they relocate to Victoria. Having had the good fortune of spending a lot of time at the Royal Melbourne Hospital and other hospitals in the Parkville precinct, I do know that there are a large amount of nurses that have relocated from other states to here in Victoria, so I am sure that that will be welcomed by many nurses to come.

Since coming to government Labor has grown Victoria’s healthcare workforce by nearly 50 per cent; that is 40,000 additional nurses, midwives, doctors, allied health professionals and other hospital staff in our health system. Almost a quarter of these roles have been created in rural and regional Victoria, ensuring that every community, regardless of location, has access to quality health care. Victoria’s hospitals now have 45 per cent more nurses and midwives than when we took office. And the Allan Labor government also continues to invest in training and recruitment programs, including the $270 million initiative to make it free to study nursing and midwifery, expanding access to training and upskilling opportunities. There are also the speech pathology grants and Australia’s first paramedic practitioner program – and I recall that coming to our chamber not too long ago. I am pleased to say that there is also an investment of $183 million in workforce initiatives in the 2024–25 budget, which includes $28 million to support health services and boost nurse workforce capacity.

Beyond the workforce investment, the Allan Labor government is delivering record funding to Victoria’s world-class public health system. In this year’s budget alone we have increased health funding by an additional $1.5 billion, bringing total health investment to more than $20 billion – over a quarter of Victoria’s entire budget expenditure. We are also overseeing – and I am delighted to update the chamber on this – a $15 billion investment in health infrastructure projects, ensuring that our hospitals, emergency departments and specialist care facilities can meet the needs of a growing population. None of this would have been possible – absolutely none – without the dedication and advocacy of our unions, particularly the Australian Nursing and Midwifery Federation.

Unions play a crucial role in protecting workers rights, securing fair wages and ensuring that our workplaces are safe. The ANMF has fought tirelessly for decades to improve working conditions for nurses and midwives. It was the ANMF, in partnership with Labor governments, that helped enshrine nurse-to-patient ratios in law and prevented cost-cutting measures that could have jeopardised patient safety. Their advocacy ensures that every reform introduced genuinely benefits both healthcare workers and the patients they serve. During the pandemic, when our health care system faced unprecedented strain, it was the ANMF that fought to secure better conditions, PPE access and support for exhausted staff. Their continued leadership is a reminder of why unions remain vital in ensuring a fair and just workplace.

On this side of the chamber we know that strong unions mean better conditions for workers, better patient outcomes and a stronger, more resilient health system. Unlike those opposite, who have consistently undermined, attacked and sought to weaken unions, Labor recognises and values the contribution of our union movement. The contrast cannot be clearer between Labor’s record of investment in health care and the track record of those opposite. When the Liberals were last in government they sought to cut hundreds of nursing jobs and dismantle nurse-to-patient ratios, attempted to undercut ratios to save $104 million at the expense of patient safety and even drew up contingency plans to replace nurses with less qualified staff.

I was very much reflecting on my time working in health advocacy as I was preparing some remarks for this bill, and can I just say that nurse-to-patient ratios and midwife-to-patient ratios are a great Labor achievement, and this bill before us is a testament to our unwavering commitment to healthcare workers and patients alike. Of course I will take a moment to acknowledge and thank again the ANMF and other nurses in the health system. I will also just take a moment to acknowledge the Medical Scientists Association of Victoria, which I know is full of members doing amazing work in pathology and testing in labs and blood banks and other places. They are the critical backbone of our medical and health system, and so too are all of the unions right across the spectrum of health. Can I thank you for all that you do and reassure you today and always that Labor walks with you in your continued pursuit of better health outcomes for all Victorians. We will never waver from our commitment to working Victorians. We will continue to build, invest in and strengthen our healthcare system, because we know that Victorians deserve nothing less.

This bill before us I was waiting for last sitting week. I must acknowledge, Minister, I have been very much looking forward to making a contribution on this bill, because this is exciting indeed. This bill before us is a testament to our commitment and our listening to workers and their representative bodies, the unions. We are not only putting policy in practice but we are putting it in legislation by enshrining it into law with the bill before us today. We are investing in our workforce, we are recognising the indispensable role of unions and we are ensuring that Victoria’s healthcare system remains strong, remains safe and remains sustainable. With the time that I have left I will take a moment to acknowledge and thank all those that worked on making this bill and their world-class commitment to the Victorian health system, and I commend it to the chamber.

Michael GALEA (South-Eastern Metropolitan) (16:54): I also rise to speak on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. We know that Labor is the party that supports healthcare workers and we acknowledge that our very impressive and fast healthcare system in this state is built on the hard work and the dedication of thousands of nurses, midwives and other support staff right across our healthcare system, and that is why we have a government that is listening to our nursing and midwifery workforce in delivering yet another improvement to nurse-to-patient ratios today.

This bill listens to the workers. Our healthcare workers are some of the most skilled and most professional in the world, and ratios are the best practice for safe patient care. I do join at this point, as many other speakers from all corners of this chamber have today, in thanking the healthcare workers, including nurses, midwives and other workers in healthcare system, who do that work so professionally, so diligently and so compassionately day in, day out, for all of us and for our loved ones at the times when we need them the most.

In 2015, under the then new Labor government, Victoria was the first state to enshrine nurse-to-patient ratios into law, and now we are continuing that leadership with the extension of stronger and safer nurse- and midwife-to-patient ratios, ensuring the best care for Victorian patients and support for their families. Because of these policies and the record investment into the healthcare system, the average life expectancy of Victorians is higher than that of all other states in the nation and is amongst the highest that you will find anywhere in the world. We have amongst the lowest infant mortality rates of anywhere in the world. We are also ahead of all other states with our elective surgery waitlist turnover rate, and we are the only jurisdiction to have treated all category 1 planned surgery patients within clinically recommended timeframes.

Indeed, being a part of many committees but part of the Public Accounts and Estimates Committee last year, as we often do, we had the opportunity to engage in outcome hearings with relative department figures for the 2023–24 budget period, and there were some quite interesting statistics in fact with regard to planned surgeries. In the previous financial year we know that 210,000 planned surgeries were undertaken in Victoria, a record for the state and indeed a 10 per cent increase on the year before. When it comes to that COVID catch-up plan in our healthcare system we know that Victoria is not just meeting but really smashing those targets, which is really, really important as we have done a great deal of work in resetting the healthcare system so that it can continue to support the needs of everyday Victorians every day of the year.

We also know that we are ahead of the national average for cardiac arrest survival rates, and I really want to acknowledge the incredible staff at the Victorian Heart Hospital as well; no doubt that is also having a significant and positive impact on the health and wellbeing of our state. It is just up the road in Clayton, just outside my region, and it serves the entire Monash Health region, and it does provide other support services right across Victoria as well. It is truly a world-class facility, and I really encourage members, if they have not already been out, to see or engage with the Victorian Heart Hospital. It truly is an incredible place with some incredible people doing amazing things in there. We are very, very lucky to have it.

This is a bill, as I said, that comes from this government listening to nurses and midwives, and we have heard what they need to ensure the quality of care that Victorians deserve. We have consulted extensively with the Australian Nursing and Midwifery Federation and others in order to get to this point today. These amendments will legislate ratios of one nurse to one occupied bed in intensive care units at level 1 and level 2. It will also involve improved staffing ratios in resuscitation cubicles on morning shifts, bringing those morning shifts into line with afternoon and night shifts. It will mandate one-to-four midwife-to-patient ratios in postnatal and antenatal wards on night shifts, which is down from one in six, as well as an in-charge nurse on night shifts in a standalone high-dependency unit. These measures will be rolled in over a measured approach, with the first bulk changes coming into effect upon royal assent, a second tranche by the end of this calendar year and the third and final tranche by the end of the following financial year. It does build on this government’s long-term investment in our healthcare system, both in those direct supports for nurses and indeed I note the recent – just late last year – significant enterprise bargaining agreement and pay award to acknowledge the very hard work that our nurses do and ensure that their pay, as much as it can be, is adequately compensating them for the work that they do.

It also of course comes off the incredible investment in our healthcare infrastructure. I have talked about of course the Victorian Heart Hospital, but we have also seen many, many upgrades in hospitals, and new hospitals in fact as well, right across Victoria. Right now we are fully rebuilding Frankston Hospital in my region as well, and it is a truly amazing site. It will be one of the largest hospitals outside inner Melbourne and serve a very, very large region in my electorate of the south-east and indeed beyond as well. It is truly amazing to see that hospital come much closer now to completion.

I, along with many others, very much look forward to seeing that. I also acknowledge the very hard work of the local member Paul Edbrooke in advocating so fiercely for that hospital. Indeed if you look at the same thing, it is right across the state, whether it is major hospitals, whether it is upgrades or whether it is primary care.

During COVID when the previous former Liberal government at a federal level completely failed Victorians, completely failed Australians and completely failed to invest in and support our healthcare system, it was Victoria and New South Wales at the time who decided to go it alone and invest, with each state having 25 primary priority care centres (PPCCs). These centres have now been repackaged and rebadged as Medicare Locals, that branding showing to the community the direct value of what they can provide to people. They have also since been significantly expanded as a result of investment by the Albanese Labor government. We still see many of those centres fully state operated, but we very much welcome the investment of 50 per cent co-funding by the federal government in a number of those former priority primary care centres, now Medicare Local services. These are really, really important services – there is one in Narre Warren in the heart of my electorate as well – many of them dotted right across Victoria. What these services do is provide a real pressure valve release for those emergency settings, for those emergency departments and for our tertiary hospital system, by providing urgent but non-critical primary care for people when they need it and when they cannot otherwise access their other primary care options.

One of the reasons of course that there was such a need for these centres was the complete degradation of primary care by the previous federal Liberal government. There were nine years of cuts and of refusing to increase the Medicare rebate, so much so that bulk-billing was pretty much almost dead. In fact for those of us without bulk-billing, doctors’ bills were going up and up and up and up. It was a complete policy failure by the federal Liberal government that has taken several years for the current Albanese Labor government to address. There is much more work to be done; it takes much longer than three years to fix nine years of sustained damage. But I do very much welcome those recent announcements by Prime Minister Albanese on Medicare, in particular supporting those primary care services, because we know how important effective primary care is and how important our local GPs are as well. That is why I am very proud to see those investments made again by a federal Labor government in this case. It does stand in stark contrast to the nine years of cuts and dereliction we saw under the former Liberal government. Let us certainly hope that we do not have a return to that, a return to those settings and a return to a federal Liberal government that would rather pursue nuclear energy than the primary healthcare needs of Victorians.

We know that they would rather put nuclear energy above Sunshine Station, above the Suburban Rail Loop and above any sort of Victorian infrastructure project, because they obviously want to go back to the bad old days under Abbott, Turnbull and Morrison of failing to invest in Victorian infrastructure. They have made that very clear. They have also made it very clear that they are now directing the state opposition leader’s policies by telling him what to do in their media releases, so that is very interesting as well. We have not seen any clear indication from the opposition leader of what he would do with the Suburban Rail Loop, but apparently Mr Dutton has decided for him. That is what we have seen from the federal Liberal government. We know that their priorities are spending completely wasteful hundreds and hundreds and hundreds of billions on nuclear energy at the expense of Victorian infrastructure and of Victorian health as well through a return to what we saw under the Abbott, Turnbull and Morrison governments: a disgraceful lack of support for primary health care in Victoria and right across the nation as well.

It was Victoria and New South Wales that stepped in – a Victorian Labor government and a New South Wales Liberal government that had to step in – during COVID when the federal Liberals completely failed to look after the healthcare needs of Australians at the time when we needed them the most. It is a Victorian Labor government that will continue to invest in those healthcare services, whether it is by continued support of the Medicare Locals – those sites formerly know as the PPCCs – or whether it is through supporting our workforce in the hospitals, such as with pay rises and these critical midwife-to-patient ratios, and indeed supporting our patients, because that is exactly what this bill does as well.

It actually goes to patient safety as much as it does to the welfare and wellbeing of our nursing and midwifery workforce. Any time that any of us in this place have, directly or indirectly, had to deal with a hospital situation – it is never normally never a pleasant experience to go through – I know I am sure I speak for many, if not all, in this place that when we do, it is always made better by the support and care of those amazing workers who go in to work each day with that dedication, with that compassion and with that work ethic to look after our health. We are seeing the outcomes of that.

When I say that the healthcare outcomes in Victoria are amongst the best in the world, you do not need to take my word for it. We know, for example, that a recent Commonwealth Fund report, the Mirror, Mirror 2024 report, compared 10 countries’ healthcare systems, including Australia as well as Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the UK and the United States. What that report found across a range of measures – whether it was access to care, care process, administrative efficiency, equity or health outcomes – was that Australia was the first overall and the first for health outcomes and equity. It also noted that as part of that Australia has the lowest healthcare spending as a share of GDP, which was interesting as well and which shows the efficacy of our health systems. That is a very, very good tick for the Australian healthcare system as a whole. This report came out just last year, so it was already in the wake of a couple of years of investments under the Albanese Labor government and after a sustained period of investment by the states, including in the state of Victoria.

On the state of Victoria, we know the Productivity Commission’s report on government services in 2024 found that Victoria was the highest overall performer of all Australian states. That was based on the 15 key measures of system performance across the domains of availability, affordability, access, equity and health outcomes. So we know that Victoria’s healthcare system is leading the nation, but that is no reason for us to rest on our laurels. Whether it is an investment in new health infrastructure, whether it is in new priority primary care centres, whether it is in mental health and wellbeing locals, whether it is in the Casey Hospital emergency department upgrade in my electorate or whether it is in major new projects such as the Frankston Hospital or the recent new major projects such as the Victorian Heart Hospital, those are all important. At the centre of the work that we are doing, though, is supporting the workforce – those incredible nurses and midwives – and that is what this bill really does seek to achieve. It does stand in stark contrast, and it is good that we have been able to make these continued investments. Indeed for the first time now under an Albanese Labor government we are getting our fair share of GST as well, I might say, which for many, many years Victoria has not received. This is now the first federal government in the entire history of the GST that has actually given Victoria its fair share of GST funding. That is a very good thing because it means that we can continue and expand those investments in our healthcare services, as well as in education services, police services, emergency services, transport and all the other very important things that get done at a state government level.

One of the most important things that any government can do, though, is look after the health and wellbeing of its citizens. We are already doing very well, as those figures in those reports clearly show, in the state of Victoria. The changes in this bill will continue to support our workforce and continue to support better healthcare outcomes for all Victorians. I commend the bill to the house.

Ingrid STITT (Western Metropolitan – Minister for Mental Health, Minister for Ageing, Minister for Multicultural Affairs) (17:09): I thank all members for their contributions in relation to the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2025. At the last election the Labor government was proud to stand with our nurses and midwives. Labor knows our health system is built on the skill, dedication and compassion of Victoria’s nurses and midwives, and we know that this was particularly true during the pandemic, where our nurses and midwives worked incredibly hard to keep Victorians safe while responding to unprecedented demand on our health system.

That is why at the 2022 election the Labor government committed to further protect and strengthen ratios. We committed to this because it is what our nurses and midwives told us they needed. The bill both reflects those needs and also delivers on those commitments. I want to thank the Australian Nursing and Midwifery Federation (ANMF) and their members for their advocacy in improving ratios and in turn improving the care and safety of Victorian patients.

I just want to touch briefly on some of the issues that have been raised in a letter to members of the Legislative Council and the government by the Australian College of Critical Care Nurses. It is important to reiterate in response to those concerns that have been raised that ratios are a minimum, and the bill in its current form does not preclude a health service from exceeding these minimums if that is their current practice. The government’s proposed amendments to the Safe Patient Care Act 2015 will allow health services to have that flexibility to support different delivery models and settings. I note that some roles may be known as different titles across different health services. I am sure Ms Crozier will want to get into the detail of that in the committee of the whole. It is the government’s clear understanding that the ANMF does not support the amendments that have been proposed by the ACCCN. The Department of Health have met with the ACCCN to discuss their concerns, and they will continue to work with health services by providing that critical guidance on the implementation of the new ratios, as has been done with previous rounds of amendments to ratios legislation.

I also just wanted to touch on a few of the issues that have been raised by members in the second-reading debate, in particular some of the issues raised by Ms Crozier. Regarding what the government has done to understand how many additional nurses and midwives are needed to implement the terms of the bill, the Department of Health have consulted on the development of the bill throughout the drafting process, but there was specific consultation that occurred late last year around workforce, and it indicated that approximately 270 additional FTE are required to deliver these amendments. Members would be aware that there is a staged process contained in the bill that allows for the rolling out in a staged way of the commitments contained in the legislation. Of course the department will continue to work with health services as these ratios are rolled out.

In addition, regarding some of the questions around the funding for delivery of the improvements to ratios, I want to reiterate that the 2023–24 state budget had specific allocation contained in it to provide for the additional FTE, but again, I am sure that I will be happy to take members – in particular Ms Crozier, who asked about this in the bill briefing – through the particulars of the budget and the provision to support nurses and midwives.

Regarding health services implementing these ratios and the assistance that will be provided to them to meet these ratios, obviously, as has been the case in previous iterations of ratio amendments to the act, the Department of Health will continue to work closely with our health services and the ANMF and Victorian nurses and midwives. There are provisions in the act to allow for health services to work with unions where health services genuinely cannot meet ratios, and that is consistent with the collaborative approach that has been practised with other provisions of the current act and the successful implementation of previous rounds of ratios.

Again, I just want to thank our nurses and midwives for the incredible work they do delivering world-class health care, despite record demand. The Allan Labor government will continue to back them in. I do understand that members may have questions in committee. I am happy to follow up those in committee, but I do commend the bill to the house.

Motion agreed to.

Read second time.

Committed.

Committee

Clause 1 (17:16)

Georgie CROZIER: Thank you, Minister, for providing some clarification. I might expand on a couple of those points. I am just wondering: could you explain why the Monash heart hospital is not included in the schedule of hospitals as listed?

Ingrid STITT: Ms Crozier, only hospitals listed in the act are subject to the ratios, so that is the schedules contained in the bill. The Victorian Heart Hospital was opened after the commencement of the last round of amendments to the act, so it is not listed.

Georgie CROZIER: So that is an oversight, Minister?

Ingrid STITT: No, I would not characterise it as an oversight, Ms Crozier. The application of the act to new hospitals will be informed by the hospital classification review, which is currently being assessed by government. Before the 2022 Victorian election the Premier of the day committed to complete a review of how hospitals are classified under the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015. This review assessed the classification system to ensure the nurse-to-patient ratios are appropriate to deliver high-quality and safe patient care. That process is not quite complete but is in train.

Georgie CROZIER: Minister, in this particular bill you have actually made some amendments around changes to names in relation to schedule 2 hospitals. It is very specific and it is highlighted in the bill. Now that the Monash heart hospital, which has got a specialist ICU, is not included in this legislation, what ratios will apply there?

Ingrid STITT: Ms Crozier, I am advised that the heart hospital at Monash is already following best practice but is subject to the broader review, which I just went to in terms of the classifications of hospitals.

Georgie CROZIER: Minister, when did the heart hospital open?

Ingrid STITT: Just one moment. I will get the exact answer for you, Ms Crozier, but I think I have already indicated that it opened after the commencement of the last round of amendments.

It was February 2023.

Georgie CROZIER: Correct – over two years ago the heart hospital opened. It has a specific intensive care unit, yet it is not listed in this round of amendments, because you forgot. The department did not include it when they included everything else. I think this is incredible, given all that I have had to listen to from the government about safer patient care and what your government is doing – yet you forgot to include the Monash heart hospital.

Ingrid STITT: You are asserting that that is the case, Ms Crozier, but I have already given you the actual answer of what has occurred here, and it is the application of the hospital classification review, which is currently being assessed by the government.

Georgie CROZIER: This is an extraordinary oversight, given what the legislation actually states and in terms of those hospitals that had to be reclassified because of their change in name. You forgot to include the Monash heart hospital, which opened two years ago with an intensive care unit. I asked in the briefing five weeks ago why Monash Health was not included, and I have not received an answer. You are telling me that it is because they were not in the last round of amendments, yet we are here debating this bill, so I ask, Minister: when will Monash heart hospital be included so that they have this legislation applied to them?

Ingrid STITT: I can simply restate the advice that I have, and that is that the application of the act to new hospitals will be informed by that classification review. That is not finalised. It is currently being assessed by the government.

Georgie CROZIER: How many other hospitals are on that review?

Ingrid STITT: Ms Crozier, what I would say in response to your question is we have very clearly listed the services which are subject to the new ICU ratios at the schedule contained in the bill.

Georgie CROZIER: I am very well aware of that, and I can read through those hospitals, if you like, but Monash heart hospital, which has been opened for two years, which has an intensive care unit, which has an emergency department, is not included in this scheduling. You have just told the Parliament that it is being reviewed, so I am asking: what other hospitals are a part of that review and when will they be coming online for this legislation to be applicable to them?

Ingrid STITT: Ms Crozier, obviously careful consideration is given to where ratios apply. That is clearly work that has been the subject of consultation with the Australian Nursing and Midwifery Federation (ANMF), and let us not forget that this bill delivers on an election commitment to the union around strengthening ratios, and so those hospitals which are listed are the hospitals that the parties have agreed and consulted around where ICU ratios will operate in the terms spelt out in the bill. But in terms of the review, it is a systemic review and it is still being considered by the government, and I do not know that there is too much more that I can add to what I have just advised the house.

Georgie CROZIER: I know that you are not the responsible minister – you are acting on behalf of the Minister for Health – and you clearly cannot answer the questions I am asking, because you do not have that information. So we are in the dark about how many hospitals are under review where this legislation does not apply. There are hospitals in this state where the ratios have to apply – the union dictates that. They tell you – the government – or the hospitals themselves whether there can be some flexibility, and I will come to that question in a minute. But there are hospitals that this legislation does not apply to – not the ratios, nothing. So do the ratios apply to the heart hospital, for the general wards in the heart hospital, or are they exempt as well?

Ingrid STITT: Well, the scope of this bill is, Ms Crozier, as you know, in respect to very specific parts of the health system in specified health services contained in the appendix to the bill. So it is in relation to ICUs, emergency departments, antenatal and postnatal, high-dependency units and coronary care units –

Georgie Crozier: Coronary care units, the heart hospital. Correct.

Ingrid STITT: Well, if I can finish, you made a few assertions in your question around things being dictated. I want to reiterate that the government is proud to have done the work with our health services and with the ANMF and nurses and midwives across the system to strengthen our ratios in those specific parts of the system broadly but specifically in the affected services listed in the appendixes.

Georgie CROZIER: I am not getting anywhere here; I think it is a massive stuff-up. Nevertheless let us move on, because the reason I ask that is in the last tranche of legislation where hospitals were required to meet the government’s legislative ratios it was the union that would then sign off, if you recall; they were the ones to say, ‘Yes, that’s okay. You don’t have to meet the ratios.’ So I would like to understand which hospitals have not been able to meet the government’s ratio requirements.

Ingrid STITT: Again, that is a sort of very narrow question about a framework that has a number of steps in place if and when a health service is unable to meet the ratios. So there is obviously a dispute process within the act, but there is also the ability for the parties to reach an agreement locally. Those are matters that are dealt with at each health service level. I know that you know that the ANMF work hard on behalf of their members to make sure that health services are complying with the legislation and, if not, either work with them in a way that provides an agreement locally or work through the dispute settlement process. So it is not a black-and-white answer of who is or is not meeting ratios. This is something that I know health services and the ANMF talk about and deal with regularly. At the end of the day the implementation planning process that the Department of Health continues to assist health services with is all about making sure that health services comply, because it is in everybody’s best interest for us to get there because it is about not only safety on our wards for our hardworking nurses and midwives but also patient safety.

Georgie CROZIER: Minister, you just spruik and sprout all of that rhetoric, but you actually cannot meet it, and that is why I am asking: how many hospitals have not been able to meet the legislative ratio requirements? Because what you are telling the community and what you can deliver are two different things, and you have not even included a raft of hospitals – we do not know who they are. The Victorian Heart Hospital, which has been open for two years, is not even included in this legislation to be able to meet what you are saying – what you are telling the community you are doing. So I just think this is farcical in one sense, because you are pretending to nurses and to midwives that you care, but actually you are not following through and doing the right work. And then what is more, for the management of these hospitals, you are not providing the support. I think it is incumbent on the government to be up-front with the community on which hospitals are unable to meet their ratios, because that then tells you another story. It is not about the intent of what the union is trying to do or the work of the hospitals or what you are trying to do; it is actually the reality of what is happening in the community and that there is a problem with staffing. I make that statement before I move on to my next question because I think it is quite disingenuous that you keep talking about how you care about patient safety when so much is being missed out. Nevertheless, could you please tell me how many high-dependency units are co-located with intensive care units?

Ingrid STITT: Just before I go to that second part of your question, there was quite a bit in your preamble. There are two things to say in response – or three, if I add the ‘nobody is sprouting’ part of my answer. The two things to draw you back to, Ms Crozier, are there are current ratios and then there are the ratios that we are dealing with in the house today, which are the future ratios. In relation to current ratios, what I have attempted to outline for you is the process that already exists in the current act. If a health service is unable to meet ratios for whatever reason, there are two mechanisms in the current act. There is a dispute process but there is also the ability to reach a local agreement, and as I am advised, these matters are worked out very well at a local level. The second part of addressing your preamble is to note that the bill before the house today has a staged rollout of the next tranche of ratios. As you would be aware, I just want to put on the record that 25 per cent of the new ratios will be implemented the day after royal assent, 75 per cent from 1 December this year and 100 per cent from 1 July 2026. Health services will also be exempt from the local dispute resolution process for any breach of the new ratios for a period of eight months for the first tranche and seven months for the second tranche, and health services in addition to all of that may also enter into a local agreement as they work towards full 100 per cent implementation of the ratios from 1 July 2026. I just want to dispel any notion that anybody has been set up to fail here. There is a good process contained in the bill which will ensure health services and the workforce represented by their union will be able to manage this in a way that is manageable for all concerned. In relation to your question around where there is co-located – just one sec and I will find the right answer for you.

That is my mistake, Ms Crozier. The trusty advisers are correct. There are 30 that are co-located.

Georgie CROZIER: Thank you for that clarification, Minister. Can I say to your preamble to the answer to that: I am not suggesting that anyone is being set up to fail here. What I am trying to understand is where the gaps are, so that when you are working through this and when there are legislative requirements people can comply. You just spoke about the dispute resolution process. In terms of that dispute resolution process, I therefore ask how many health services have not been able to comply and whether they have had to go through that process.

Ingrid STITT: That is not data that I have available to hand, Ms Crozier, because individual health services manage that. It is not centrally managed by the department.

Georgie CROZIER: When you are developing this legislation and you are wanting to try and have health services comply with the legislation, then surely you would be asking: have there been any problems with the previous two tranches of these ratio bills? It appears from your answer just now, Minister, that the government is not even monitoring this. It is quite extraordinary. I am perfectly happy if you want to take it on notice and come back to me about how many health services are having trouble meeting the ratios or whether any have breached them so we know where this third tranche of legislation will be going. I just think it is in the interests of transparency, and I think it is incredible that the government is not following that due process.

Ingrid STITT: Ms Crozier, they are two different questions. You asked about how many health services have had issues with meeting the ratios. I said to you that that is not data that is kept centrally by the department, because each individual health service manages those issues in accordance with the process set out in the act. That is a different question to whether or not we consulted about the development of the bill, which of course we did. You implied that there was a lack of consultation about the development of the bill in your question. They are two separate issues. There was extensive consultation in the development of the bill, as you would expect.

Georgie CROZIER: Your interpretation of what I was asking is very odd, but let us go to the consultation process, because there are actually some questions I have for you, Minister. Given the letter that I received from the ANMF last night, given the correspondence that I have received from dozens and dozens of midwives and intensive care nurses and others that work in the area and also from the College of Intensive Care Medicine and the Australian College of Critical Care Nurses and given that in the briefing I asked you who you had consulted with and I have not had an answer, did the government just consult with the ANMF? You said in the summing-up that you consulted with the ACCCN. When was that?

Ingrid STITT: I can confirm for you, Ms Crozier, that there was significant consultation that occurred at different stages of the development of the bill. The organisations that were involved in consultation included the ANMF, the Health Workers Union, the Victorian Hospitals Industrial Association, the Victorian Healthcare Association, the public health services, Safer Care Victoria and public health service executive directors of nursing and midwifery, who are members of the Safer Care nursing and midwifery council. In addition to that, there were a number of central agencies and departments which were consulted about the potential impacts of the bill.

In addition there were some discussions held with the ACCCN and the Department of Health, where they went through –

Georgie CROZIER: When?

Ingrid STITT: On 28 March. As you would have gauged from –

Georgie CROZIER: Three days ago. You are kidding me.

Ingrid STITT: Ms Crozier, with a very straight bat I am answering your question, and you would know, if you had read the ANMF correspondence that you just referred to, that the ACCCN has a number of members which are also members of the ANMF.

Georgie CROZIER: I find it incredible. The government wanted to debate this bill in the last sitting week, two weeks ago, and yet we have just had it confirmed by the government that they did not even consult the ACCCN, the Australian College of Critical Care Nurses, until three days ago – extraordinary. Nevertheless, that is why there is confusion, and that is why I am getting dozens of emails from intensive care nurses. It probably says it all.

I am going to move on. Minister, could you please, as you said you would in the summing-up, provide some clarity about the $103 million in the budget papers?

Ingrid STITT: As tempting as it is to go back to those other issues, Ms Crozier, I will resist. Just for clarity, the 2023–24 state budget committed $101.3 million over three years and $59.868 million ongoing for the ratio improvements to be legislated in the act and to fund the ongoing wages of additional nurses and midwives required to meet the new staffing ratios – just for completeness. That can be found in the ‘Admitted services’ section of budget paper 3. It forms a component of the line item under the heading ‘More support for our nurses and midwives’.

Georgie CROZIER: Thank you for that clarification. I will go back and have a look at that. Given you said in your summing-up that there was a total of 170 FTE –

Ingrid STITT: Approximately 270 additional FTE.

Georgie CROZIER: 270 additional FTE. The letter from the ANMF to me last night says:

For Level 1 and Level 2 ICUs this was to fund an additional 160 full-time equivalent (FTE) …

Where are those other 110 nurses that you have stated going to be employed?

Ingrid STITT: I can certainly seek some more advice from the box, Ms Crozier, but that is the amount of additional FTE that I have been provided information about. That is based on data received from health services in August 2024 about what they would require to meet the needs of the bill. But I would add that of course there is a staged process of implementation, and health services continuously are adapting their operations to meet their staffing needs. The department will continue to work with health services on their staffing requirements to meet the ratios.

Georgie CROZIER: If there was $101.3 million over three years for the election commitment, as highlighted by the ANMF, of 160, will there be additional money required for the 110 that you have suggested are required given that assessment that you did in August last year?

Ingrid STITT: Ms Crozier, I am advised that the budget provisions, because of the staged nature of the rollout of the ratios, will cover the costs of implementing these commitments. I guess I would add that there are other workforce initiatives in the health system more generally that go to providing a strong pipeline of nurses and midwives. Whilst I accept that your question specifically relates to how the additional ratios will be funded across the system, it is important not to ignore the fact that there are other significant investments across the workforce in terms of building that strong pipeline of nurses and midwives.

Georgie CROZIER: I just need some clarity. The $101.3 million is for the implementation of nurses and midwives in this latest tranche, but then you have just said ‘other initiatives’. This is totally to meet these requirements. I have had some correspondence from a health service, to go to your point about the department working through this, and they have said that it remains fluid, with ongoing discussions. This is in the last couple of days. It is very fluid – four to 14, or even more than that. They are still working through their budgets. How is that going to be determined and what additional funding do you see is required, given the work you did in August last year? Clearly the health services are still finding it very, very difficult to assess exactly what they are going to require given this legislation.

Ingrid STITT: The commitment in the state budget in 2023–24 is $101.3 million over three years, but it is also $59.868 million ongoing. In addition to that, I would just reiterate that 25 per cent of new ratios have to be implemented the day after royal assent, then 75 per cent from the beginning of December this year and then 100 per cent in July next year. The very clear process, having learned from the first two tranches of ratios, is for the department to continue to work closely with those health services around support to make sure that they can meet these ratios. That is the advice I have about the budget commitment and the ongoing nature of that funding.

Georgie CROZIER: Minister, given you could not answer the questions about whether hospitals were having difficulty meeting ratios under the previous legislation and you have just said the department will be working very closely with our health services with this tranche – as you said, it is 25 per cent after royal assent and then ongoing by December 2025 and 1 July next year – will the department be monitoring who can and who cannot meet the ratio requirements? Will it be reported and how will it be monitored?

Ingrid STITT: I have clearly said that there is a role for the department to continue to support health services in implementing the ratios. There is also the fact that the dispute settlement process does not apply for a period of time and that health services may enter into a local agreement as they work towards a 100 per cent implementation of the new ratios from 1 July next year.

I think that it is the expectation that health services continue to work closely with the department on the implementation of these requirements once the bill passes the Parliament. That is why there has been careful consideration given to the staging and the rolling out of these ratios.

Georgie CROZIER: Minister, in light of your response just then, has there been any risk analysis on whether the new staffing ratios will lead to budgetary restraints in other areas of hospital budgets, such as planned surgery, or other services they provide?

Ingrid STITT: I know you are not trying to conflate the issues, but I would not accept that there is any negative impact for health services on complying with the ratios. This is about strengthening our nurse-to-patient ratios in very specific parts of the system, and I would argue that that is going to provide better health care for those Victorians that our nurses and midwives are caring for in the health services that are subject to these strengthened ratios. More broadly, health services will continue to work closely with the department and Hospitals Victoria on their overall budget and comply with their statement of priorities as a normal part of those processes.

Georgie CROZIER: Thank you, Minister, for that reassurance. Given the last year, the uncertainty, the cuts to health services were going were significant – health services, you are well aware, have to work within their allocated budgetary requirements. If they cannot find the staffing or the staffing is not available and bed closures occur as a result of not having those staff to meet the ratios in emergency departments or intensive care units – some of the planned surgery needs to be admitted into ICU post surgery. If some of these hospitals cannot meet that requirement, it is going to have an impact, so that is why I asked. I am pleased that you are reassuring the house that is not going to occur.

Minister, if I can go on to an example provided by the ACCCN and the College of Intensive Care Medicine (CICM). I spoke about it during the debate. They provided an example of – I am not going to go through all the levels – a typical level 1 ICU with a 28-patient ICU and a six-patient high-dependency unit proposed to be staffed. As a comparison, the ACCCN says an ICU with a one-to-one ratio has 28 beds and a high-dependency unit with a one-to-two ratio has six beds – that is three staff. They claim an assistance, coordination, contingency, education, supervision and support (ACCESS) nurse, which is their contention. I have spoken to the head of the union and talked about the titles – different health services have different titles. In their example they spell this out: an ACCESS nurse, which is important in relation to the functioning of an intensive care unit, is one to 10, so that is three; a team leader is one to 10, so that is three; and a nurse in charge is one. That is 38 staff. Then the bill, as spelt out, does not have that ACCESS element, and so that takes it back down to a 35-staff number.

By counting the ICU liaison as part of the ICU staffing numbers and then removing them from the actual care team in ICU, you have reduced staffing levels to below current minimum numbers as defined by the ACCCN guidelines. Why has the government done this, and is it a cost-saving measure?

Ingrid STITT: Ms Crozier, you are right; there are different titles that exist in different health services. The ACCCN’s workforce standards specify for ICUs with greater than 75 per cent of qualified ICU nurses and where less than 80 per cent of ICU beds are in single rooms, one ACCESS nurse per eight patients per shift. I guess the thing to say about that is that the bill does not define the classification of team leader or liaison nurse, allowing health services the flexibility to support different service delivery models. These roles may also be known by different titles across the Victorian public health service – for example, team leaders may also be referred to as ACCESS nurses.

I think there has been a little confusion around these issues as a result of receiving the ACCCN’s correspondence. For level 1 hospitals the bill specifies there must be one team leader for every 10 occupied beds for all shifts, and the ratios are a floor; this is not intended to be a cost-cutting measure. I can confirm that this is not to cut costs. This is really an issue around different classification and terminology across some health services, which has caused a little bit of confusion. But the government stands by the provisions of the bill in terms of what would be required in those units.

Georgie CROZIER: If I can go to a typical level 2 ICU with 10 ICU patients and four high-dependency unit patients, which is proposed to be staffed as: ICU, one to one, 10 beds; high-dependency unit, one to two, four beds; and ACCESS , one to 12, one – and there is again nothing in the bill to suggest that ACCESS, and we have just gone through the terminology and how that is applied. To break it all down, when you have got a team leader and a nurse in charge, you have got the liaison or outreach nurse or whatever the term is, on the AM and the PM shifts, but under the ACCCN standards they should be covered for all shifts. I noticed that in the ANMF’s frequently asked questions it clearly shows this – that a night duty shift is not covered. It does not have that provision and therefore does not have that support. It does not have a liaison or outreach nurse, or however it is titled, during a night shift. Why is that?

Ingrid STITT: Ms Crozier, the level 2 hospital ICUs generally have a lower level of patient acuity and lower ICU bed numbers when compared to their level 1 counterparts, and as such the decision has been made not to legislate the liaison nurse on the night shift in level 2 ICUs, considering the lighter patient load and reduced necessity for certain duties during this time. But I would just again restate that the ratios in the bill are a minimum requirement; there is nothing to prevent services that are operating above the minimum ratios from continuing those arrangements.

Georgie CROZIER: Minister, I find it really curious that in the general wards and other parts of the hospital ratios must apply. You are saying that in a level 2 hospital intensive care unit that has that the workload is generally lighter than a level 1 hospital. I would say, yes, the complexity could be not as complex with those patients in a level 2 hospital. However, the workload is exactly the same as if not more than a general ward, where they have specific ratios, and yet this is covered in the a.m. and p.m. shifts but not the night shifts. I take your explanation that you see it as not being as critical as the level 1 and that is why the government has not made that provision. If I could ask, therefore: the ICU liaison outreach role in Australian hospitals is an advanced practice nurse; they are very specialised. So is the ICU liaison role in the bill intended to describe this same role, or is it something different?

Ingrid STITT: Just to clarify the previous answer I gave you, Ms Crozier, I was referring to patient acuity and lighter patient load, not workload.

Georgie CROZIER: I just want to correct the minister: I am very well aware it was not the workload – and that was my point – it was the patient acuity. That is right. When they are in intensive care they are complex. It is not about workload; it can be just as demanding as a patient who is postoperative with less complications on a general ward. I know this – I know it very well. I have worked in these areas. I am just curious why you have not applied this in an intensive care unit in a level 2, where you said that it was not regarded in the same way as the workload for a level 1.

Ingrid STITT: Ms Crozier, my apologies, but would you just repeat the first question about the roles that you are asking about – the team leader and the ICU liaison role?

Georgie CROZIER: Yes. I know that there are different titles for this, but the ICU liaison outreach role is generally regarded in Australian hospitals to be an advanced practice nurse, so they are a clinical nurse, consultant or a name such as that – they have specific roles. The question is: is the ICU liaison role in the bill intended to describe this same role, or is it intended to be something different?

Ingrid STITT: The team leader role, you mean?

Georgie CROZIER: In the ANMF’s frequently asked questions it calls it ‘the liaison outreach nurse’, so it is really that that I am referring to, not the team leader – that is a different role. It is very well spelt out – in the bill there is team leader, there is nurse in charge, and there is the liaison outreach. So it is very clear; it is completely different from the team leader.

Ingrid STITT: Thank you for that clarification. The advice that I have got is that the team leader and the ICU liaison roles are two separate roles with distinctly different responsibilities.

Georgie CROZIER: I know that. It is very clearly spelt out in the bill that the team leader and the liaison outreach are two different roles; I am very aware of that. What I am asking you about is this liaison outreach role, regarded by the ACCCN and others in Australian hospitals – it is not just Victorian hospitals, it is right across the country – as an advanced practice nurse. They are very specialised in what they do, and they are often a clinical nurse consultant or they have other specialist training to provide them that ability to undertake these roles. The question is: is the ICU liaison role in the bill intended to describe this same role – so that nurse who has that clinical expertise – or is it something else?

Ingrid STITT: The intention of the liaison role is outreach. They provide clinical leadership and assistance both within and outside the ICU.

Georgie CROZIER: The intention of an ICU outreach liaison nurse is to provide expert clinical care to patients outside of the intensive care unit who are most at risk of clinical deterioration in order to optimise their care. This is most acutely needed in many instances after hours or on nights and weekends, when you do not have the medical expertise and others in these very busy intensive care units, yet the ratios are higher during the daytime, according to the legislation, during the a.m. and p.m. shifts. When there are less medical and other senior clinicians available at night, it is not there. So the question is: why haven’t you included that support for these nurses as well to provide that safe patient care that the legislation is designed to provide?

Ingrid STITT: I refer you to the previous interaction we had around the level of acuity and the differences between level 2 and level 1 hospitals.

Georgie CROZIER: Minister, this is my final question, and it goes back to the issue around breaches. I am just wondering: have there been any referrals to the Magistrates’ Court under section 42 of the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act since the current ratios have been in place?

Ingrid STITT: I will check to see if we have got that information.

I will have to take that one on notice, Ms Crozier.

Sarah MANSFIELD: Minister, as you are aware, the public mental health workforce are actively seeking improved staff–patient ratios at present. Why haven’t ratios in mental health settings been included in this bill?

Ingrid STITT: The scope of this bill is very narrow and relates to acquitting an election commitment made to the ANMF for very specific parts of the general health service, so it is very much confined to those issues. As you are aware, there is bargaining going on currently with our mental health workforce, including mental health nurses. There are a number of different staffing matters that are relevant to the issues that you raise, but those are ongoing negotiations that are live now in the bargaining, and that is the appropriate place for those discussions to continue.

Sarah MANSFIELD: There was a previous commitment made around mental health ratios as well by the former Premier. You mentioned that the current enterprise bargaining agreement process is where some of this is being worked through, but there have been previous commitments made by the government, so can we expect to see some movement in this space at some point in the near future?

Ingrid STITT: I am not in a position to pre-empt the outcome of the bargaining. I do know that minimum staffing profiles are issues that are being actively discussed by the parties to that agreement, and I do not wish to cut across those negotiations. We will have to see whether bargaining resolves those claims. But I do know that they are the subject of ongoing discussions.

Clause agreed to; clauses 2 to 20 agreed to.

Reported to house without amendment.

Ingrid STITT (Western Metropolitan – Minister for Mental Health, Minister for Ageing, Minister for Multicultural Affairs) (18:13): 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) (18:13): 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.