Safe PatieNt Care (NURSE TO PATIENT AND WIFE RATIOS)

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 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.