I also rise to speak this evening on the very important Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Bill 2015. This is the second bill I have spoken on today that is an election commitment being honoured by the Andrews Labor government. More than that it is also an Australian first to see the ratio issue bedded down in legislation. We do this because we believe the ratio issue will improve the quality of care for the hundreds and thousands of Victorians who use our public health system. There are 50 000 nurses and midwives in the public health system in this state. They also now, through legislation, will have their work respected.
It is fair to say that the science is settled on improved ratios and patient care. It is true that there have been ratios in Victoria contained in enterprise bargaining agreements since 2000, and they have worked. There has been a 16 per cent reduction in the risk of mortality in surgical patients with high registered nurse staffing. There have also been increased ratios in relation to the rate of falls, deep vein thrombosis and cardiac arrest, to just name a few of the improved outcomes that have come about as a result of increased nursing hours.
Hospital stays have become shorter because people are less likely to suffer complications. These findings are not unique to Australia; they are observable around the world.
It is fundamental to a world-class health system that patient safety is the absolute priority. Patient safety is not something to be haggled over at the bargaining table. It is not a workplace condition. Patient safety and optimised outcomes — or, in plain English, coming home safely — are what Victorians expect from their hospital system. Regrettably, in the last round of enterprise bargaining, which was under the previous government, we saw a very drawn-out campaign of nine months that targeted ratios, amongst other claims. I would characterise that dispute as pointless, in many ways misguided and in lots of ways downright nasty. I am sure many people in this chamber and among those who are listening will remember photos in the newspapers at the time of a well-known Liberal member giving a rather rude hand gesture to nurses. It caused enormous embarrassment for the then Premier, and I am sure for those who are sitting in the chamber tonight as well.
Unfortunately, fraught industrial disputes bring out some very hot-headed elements; that just seems to be the case. But that will not be required under the new principal act introduced by this bill. This bill takes ratios out of the industrial framework. Nurses and midwives will know that work intensification debates will take place in an industrial relations setting. In short, their work will now be respected in law, and that is the key thing. Just as importantly Victorians can be sure that no future government will launch into short-sighted attacks on patient safety under the guise of cost cutting.
This bill does three things. Firstly, it sets out the numeric nurse-to-patient and midwife-to-patient ratios that are already in place, outlining specific requirements for the minimum number of nurses or midwives for a set number of patients. These provisions vary across different hospitals, different types of wards and different shifts and are intended to replicate the arrangements and scope contained within the current public sector nurses and midwives enterprise agreement.
Secondly, the bill retains some important elements of the enterprise agreement relating to the interpretation and application of the ratios. These provisions allow both employers and employees some flexibility to propose and negotiate variations of ratios to allow for a further refinement where required. It is important that the act be flexible enough to factor in local needs and issues, while keeping pace with the evolving nature of health care.
Thirdly, the bill introduces a compliance and enforcement regime. As ratios will no longer be subject to the enterprise agreement, the Fair Work Commission and the commonwealth Fair Work Act 2009 will no longer have jurisdiction to conciliate, arbitrate and otherwise deal with matters relating to ratios. This enforcement regime includes specific direction powers for the Secretary of the Department of Health and Human Services to ensure that health services are compliant with ratios. These powers can be utilised by the secretary either pre-emptively or following the declaration of a court.
The bill sets out an alternative enforcement regime under Victorian jurisdiction whereby the Magistrates Court of Victoria could be referred a matter that cannot be resolved at a local level. The enforcement regime replicates the enforcement mechanism under the enterprise agreement, and it is intended to have a similar effect to the dispute resolution arrangements under the enterprise agreement and impose no additional burdens on any of the stakeholders.
For serious and wilful breaches of ratios or ratio variations the Magistrates Court may, at its discretion, impose a civil penalty of up to 60 penalty points — a bit over $9000. This, combined with reporting requirements, is enough to deter hospitals from breaching the requirements of the act. The health services will also be required to report on any breaches as part of their annual reports. None of this is controversial.
The first two points are what has existed in enterprise agreements for 15 years, and a Victorian jurisdiction has been introduced as it is Victorian legislation. All we have done is remove patient safety from the industrial relations framework and show respect for the work undertaken by nurses and midwives. Much of my electorate is in rural and regional areas, and I noticed the rather strident contributions that were made in the other place about how these changes will have an impact on and will affect rural hospitals. Some of those concerns have been reiterated in this house tonight by the previous speaker, Mary Wooldridge. It is important that I clarify that these concerns are, I believe, quite erroneous.
Firstly, opposition members raised that they were worried about compliance. The compliance penalties are for ‘serious and wilful’ breaches. The dispute resolution procedure is aimed at local resolution. Hospitals will not be fined if someone is 5 minutes late for work. They will not be fined if there is a natural disaster swamping them. These concerns have no basis in fact, and if there are still concerns, then they will be of a genuine nature and people will be sitting down and working them through
Secondly, opposition MPs have been worried that lower country ratios are entrenched. The whole object of this legislation is to maintain the flexibility that has been built into the system and tested over the last 15 years through the enterprise bargaining agreements.
Thirdly, opposition MPs have stated that this bill ignores depleted workforce issues in rural areas. To be clear, the bill has been drafted recognising the challenges faced by small rural hospitals in recruiting staff from an often depleted workforce market. The bill includes transitional provisions allowing any ‘below ratio’ arrangements already in place, referred to as a current workload management arrangement, to be continued for one year.
This provision gives hospitals with a below ratio arrangement in place up to 12 months from the commencement of this bill to either propose a variation to the ratio using the relevant provisions in the bill or adjust their rosters to meet the ratio requirements. This will allow the health service some time to consider which of these options is most appropriate to address its circumstances. The ratio variation arrangements within the bill enable these services to address their specific challenges through the utilisation of the flexibility provisions through either entering into a formalised variation from ratios proposal, which is similar to a proposal under clause 42 of the enterprise agreement, or by entering into a formalised local agreement.
In short, this bill is not about reinventing the wheel. It seems that those opposite are intent on coming up with all sorts of excuses to criticise this bill, and I hope this is not a baseless fear campaign that those opposite are trying to stir up. This is an election commitment that respects nurses and midwives and their work. It is designed to stop future governments from attacking the standard of care in our healthcare system.
Any attempt to say otherwise by raising unjustified and unfounded fears in rural communities is spurious and ill founded. The facts are that during the consultation process for this bill we received widespread support from across the health sector. Health services and employees alike recognise the irreplaceable role that nurses have in our health system and our lives, and patients do too. If life goes wrong and you end up in hospital, nurses are the health professionals at the pointy end of health care who are doing their best to give you the best care in the world. Conversely, it is midwives who share one of the greatest moments in life — that is, the start of life. The public respects the work of nurses and midwives, and so does the Andrews Labor government.
The Andrews Labor government looks forward to working collaboratively with the Australian Nursing & Midwifery Federation as well as public hospitals, public health services, denominational hospitals and multipurpose services to make sure that these changes are discussed in a clear and timely manner. That is why this bill comes into effect after the new enterprise agreement is arranged. This will ensure and enable a smooth transition. Health care continues to evolve. This bill has flexibility at its heart and can cope with technological changes. The government will continue to work with nurses and the health services to make further improvements to these ratios over time. This bill will help nurses and midwives to provide the very best care they can.
In terms of some of the comments made by Ms Wooldridge, ratios are not new. Labor chose to step up by enshrining them into legislation, but it was the former coalition government that chose to run an ugly campaign against nurses and their unions last year. I commend the bill to the house.
