Second Reading: Safe Patient Care (Nurse To Patient And Midwife To Patient Ratios) Amendment Bill 2020

I rise today to speak on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2020. This is a bill that fundamentally does three things. It amends the rounding methods used when determining staffing requirements for nurses and midwives; it amends the Child Wellbeing and Safety Act 2005, requiring certain maternal and child health services to employ nurses who have prescribed maternal and child health nurse qualifications; and, very importantly to nurses and patients in my electorate, it reclassifies the Warrnambool Base Hospital as a level 2 hospital—and, might I say, not before time. But I will have more on that subject throughout my contribution.

First of all, I will ask for just a bit of latitude to explain why I am the lead speaker on the bill, given my portfolio is actually freight, ports and country roads. That could be a question being asked at the moment. The member for Lowan is usually the lead speaker on the health bills, and I just want to take a moment, if I could be given that opportunity, to wish her well. She has recently given birth to a little girl, Ella, and I just wanted to take a moment to congratulate Emma, her partner, Chris, and her young son, Harvey, and wish her all the best during these early first few weeks when she will be enjoying that time with her daughter.

I would also like to acknowledge that the member for Euroa is having her last week in the house and in the next short few weeks will be giving birth to her first child. I would like to take this opportunity, whilst we are talking about midwives and nurses, to wish Steph well. I am sure she will be the beneficiary, as Emma has been, of the good care that will be given to her under the skills and expertise of the midwives that she will be very appreciative of—let me say, I am sure of that.

So that takes me back to the bill. The bill does, as I said, amend the rounding methods and is improving the nurse-patient ratios for nurses and midwives. Now, I just want to take you back a little bit, first of all. We have just been through an extraordinary period of time facing a pandemic. So nurses under normal circumstances are very, very hard workers, are real heavy lifters in our community. I just want to talk about the fact that this bill does actually implement the ratios so that patient care can be guaranteed. I think it is important that we acknowledge the hard work that nurses do under any circumstance.

I was just reflecting when I was preparing for this bill that I worked as a nurse for some 30 years, and early in—

A member interjected.

Ms BRITNELL: Yes, I know I am really old.

Mr Foley: You must have started when you were a child!

Ms BRITNELL: Well, we did. We started at 17. We did our six weeks preliminary training school and learned how to wash a patient, and that is what I was reflecting on. I was reflecting on how busy it is on the wards. So here we were facing a pandemic, where the nurses and the doctors and the administration staff were doing the normal work of a daily shift and preparing the hospital. So on a normal shift you get to work way before the time you have to start, because you have got the night duty staff, if you are on a morning shift, who have worked all night and you are not going to turn up late for work when someone needs to get home to often get their kids to school before they can even get to bed.

So you are sitting there at 7 o’clock on the knocker, ready to actually start, getting your patient handover. You are out on the wards by 20 past. You are sitting up your patients, you are giving your insulin, you are making sure your patients have got their pain management administered. You are checking your drugs because even if the doctor has ordered it, if you administer the wrong drug that has an interaction with another drug you are giving or even if it is ordered and the order is wrong, you are responsible. You have got doctors rounds to work with. You have got patients who are receiving difficult information. You have got to be aware of their emotional wellbeing. You have got to get them off to X-ray. It is a really busy time. So nurses work very hard. Their patient workload is usually quite high, and that is why it is important I think to have nurse-patient ratios. It does not come without challenges.

Now, with nurses you do not just finish at the end of a shift. It is quite difficult to not be affected by a young woman getting diagnosed with cancer when her children are the same age as your children, and you sit there and you are holding her hand and you are helping her through that difficult time, or an old woman whose family are away and has got no support around her. There are all sorts of challenges that people face when they are in hospital and under pressure. So the nurses are extraordinary people, and I do want to make it known. Thank you to the nurses and staff of hospitals who work under those extreme pressures and do an extraordinary job. I will focus a bit more on that when we get to the Warrnambool Base Hospital part.

Now I want to take you back in history. So just before the 2014 election the Labor Party promised nurses that they would get the nurse-patient ratio legislated. The Labor Party won the election in 2014, but it was not until 2018, so nearly four years later, that they actually came good with their promise to implement the nurse-patient ratio changes that they had promised. So here I have the bill that was originally proposed, which was a 35-page bill, which is a pretty flimsy sort of effort—not as flimsy as the one that I have got in front of me here, of 13 pages, which is what we are actually passing today. But this 35-page bill was actually flawed. So despite the Labor government, who says they are the friend of the worker, saying they would legislate for the changes, they did not do it for four years. They sat the least amount of time that any government has sat for the previous century and yet they stood beside nurses saying, ‘We care’.

The evidence of how much they care was in this bill—a flawed bill, which did not understand the difference between a midwife and a nurse. We, as the Liberal-Nationals, opposed it because it did not do what it was intended to do, and the last thing we need are bills with unintended consequences, which is what we see from this government time and time again. Because what they do is a lot of spin and not enough work to make sure the spin has more than just words behind it and actually has the facts that will implement the changes that are needed. This bill, with the poor understanding of the difference between nurses and midwives, went right to the death knell. They did not introduce it in the upper house till the last day of sitting before the 2018 election, and it failed because it was flawed. There is a big difference between a nurse and a midwife, and midwives should never be made to feel less valued than nurses. We work as a team when we are in the wards, we work well together, and putting this sort of legislation, which would put a divide between nurses and midwives, was simply ridiculous—or insulting, sorry, a much better word for the situation.

The other thing was that the Warrnambool Base Hospital nurses—also Victorian nurses—were promised that they would be part of the nurse-patient ratios. But guess what? Not only was it flawed because it did not understand the difference between nurses and midwives, it also left off Warrnambool Base Hospital.

So let us go up now to the 2018 election. Despite the fact the Warrnambool Base Hospital nurses were promised that the patient ratios would apply to them, they were completely ignored. The Labor candidate, Kylie Gaston, sidled up to the Warrnambool Base Hospital nurses and said, ‘If you elect Labor, I will make sure we reclassify the hospital to a level 2 and then we can implement the nurse-patient ratios’. That is the article that appeared in the paper with that promise that day. Here is Warrnambool Base Hospital working in enormously challenging circumstances, desperately in need of an upgrade to accident, emergency and theatres at the very least, and we, as the Liberal-Nationals, had promised—Denis Napthine, the Premier at the time, promised—that we would do that in 2014. We re-promised for the 2015 by-election when I was elected, and we recommitted again during 2018 when I was re-elected into this place. Unfortunately we did not win the election, so we have not been able to fund that.

But the Labor government, who won the election, have completely ignored the very hardworking staff at the Warrnambool Base Hospital. Not only did they not involve them in the first bill but they then reintroduced the bill when they got in in December 2018. When they got in, that was one of their first bills, and—lo and behold, guess what—they forgot Warrnambool Base Hospital again. So the Labor candidate had, pre-election, made the promise that they would be changed to a level 2 and would be brought in under the changes of the nurse-patient ratios, and they were not. Labor completely ignored the nurses of Warrnambool Base Hospital once again. So here are these nurses, working in extraordinarily hard circumstances in accident and emergency and theatre and right across the hospital—because when those nerve centres are under pressure the whole hospital is under pressure. So you have got staff stressed. I described a typical ward day, and I had not even got to morning tea with my description of the pressures of trying to work on a busy ward, let alone in accident and emergency when you have got, say, a cardiac patient turning up with chest pain who is at risk of having a cardiac arrest, a motorcyclist after an accident who is needing his leathers cut off and a child who is having perhaps—I am just trying to think of something off the top my head—a high temperature convulsion and you have got your stressed parents. Just that alone, in Warrnambool—which is kind of normal stuff—would put that environment under enormous pressure. So these staff work under that every day.

In 2018 the election promise was ignored. The government, I think, shunned the Warrnambool Base Hospital. There was no funding for the upgrade, and no legislation for the nurses to be included in the legislation. So what happens then? We get to 2020, and here we have a 13-page bill. That is how hard their job was. The government did not sit very much—less than anyone else. They cannot use the excuse that they were busy. The department helps them with their legislative writing. It is only 13 pages, and the other one was only 35 pages. Go and have a look at some of the other bills; they are usually much more dense than that. And so here we are today with a bill that actually finally includes Warrnambool Base Hospital nurses. But guess what? The bill is flawed—you heard it. At the start, what did we have to do—put a house amendment in, because there is already a mistake in a 13-page document. Does this tell you that they care? Does this tell you that what they have actually really been focused on is themselves—getting re-elected, getting into power and staying in power? What is their job if they cannot get the legislation right? They have had, what, three goes at it now, I think we are talking here.

Let us move on to what this bill will do. This bill will include the Warrnambool Base Hospital in the nurse-patient ratios. However, to do that you need money, because you cannot just go and employ 20 more nurses without extra money unless you compromise services—you reduce services somewhere else. And that is what I am worried about, because this bill has lots more spin. The government says, ‘We’re introducing it’, and Warrnambool gets very excited, but the implementation of this is not for another two years. We are talking nine years waiting. That is not very respectful, is it—not very respectful at all. So nine years waiting and still no mention of funding for the hospital build. But do not get confused between the two things. I am actually talking right now about no funding accompanying this. Now, in 2022 there will not be the spin that we have just seen about, ‘We’re finally giving the nurses at Warrnambool what they’ve been asking for for seven years’. There is going to be another two years before they get it. There will not be any spin and hullabaloo then, but I will be watching very, very carefully, because if the money does not accompany that, if we have to compromise services somewhere else because they have to employ the 20-odd extra nurses but there is no extra money, then I will call that out.

Now, you might say I am being cynical. Well, you know what? This has happened before. Remember when we got a new public holiday? Well, ask the CEO of Port Fairy hospital, Jackie Kelly, ask Christine Giles from the Portland hospital or ask Craig Fraser from Warrnambool Base Hospital: did they get extra money when they are paying triple pay on a public holiday to cover the extra costs of the nurses?

Mr Rowswell: I know the answer to this.

Ms BRITNELL: You know the answer? Why do you know the answer—because there is a real pattern, isn’t there? There is a real pattern. No, what they have to do is use their global budget and compromise something else, so we lose services.

The government puts the spin out that they are actually helping and there will be 20 more nurses. Well, I will tell you what else they will do. You try and have a look at the budget and figure out in 2022 if you can see where that money is or is not, because they will change everything, they will have different line items. This is what they do in their portfolios so it is almost impossible to see whether there is new money. We know this government is a government of corruption and of deceit. We know this is a government rotten to the core, so why would we expect anything other than this?

So, Warrnambool Base Hospital nurses, it is my promise to you as a fellow nurse who knows how hard you work, who respects what you do and who has been a patient and appreciative of your work, that I will watch very, very closely and in 2022, nine years of waiting for this bill that you were promised, I will stand beside you and make sure you get that money. Now, the cynic in me suggests that the extended time line is a well-advanced media strategy for a photo opportunity for the next Labor candidate. That is what I am really worried about, because we have seen so much of it. We have seen these photos in the paper of the Labor candidate or the Labor minister saying they care. I hope you are listening, because what I have identified to you is a time line of the promises that were not delivered and how in nine years you have been told you will get it, you have had a carrot dangled in front of you, and no, you have not got it.

But do you know what? The government could do something right now to help. We have just had them loan $24.5 billion to get us back on track after this pandemic. Well, Warrnambool Base Hospital is shovel ready. It has been shovel ready for a very long time. The feasibility studies, the master plans and stage 1 of the hospital are complete, well and truly, so what we should have seen at the last budget and the budget before—the last five budgets in fact—was the money delivered. But what we did see was more hullabaloo—$7.5 million given to a consultative committee so we can do more feasibility and more master plans. Well, excuse me—

Mr Rowswell: What a waste.

Ms BRITNELL: What a waste—that’s exactly right.

We need to get on. We know we need accident, emergency and theatre at the very least. Of course we have got to do planning, but we have done all that planning. It was a smoke-and-mirrors ploy. That is what it was.

I will move onto another aspect of the bill, and that is the maternal and child health nurse element. I was part of the perinatal inquiry. In that perinatal inquiry we had many people from right across the state talk about the challenges in perinatal care. It also extended through to supporting young families and how we can prepare—this is prior to the pandemic—Victorian families and make sure families get the support they need. We do not have the extended family we used to have around us, and it is a really challenging time for a young family to make some changes.

I heard a lot about the valuable work of maternal and child health nurses. It is great that we have got legislation to say we have got appropriately trained nurses in this role. Now, to become a maternal and child health nurse you do your general, then you do your mid and then you do maternal and child health nursing. That is a triple-certificate qualification—quite an expensive investment. In the country and the regions, for example, if you are a maternal and child health nurse, you often stay in that job, traditionally we have seen, for often 20-odd years. If you are a young 25-year-old and have just finished your general and your mid, why would you go off to uni and do maternal and child health nursing, if you have married a man in Hamilton, for example, and you have got your nursing career there and he has got his farm there? Often you are not going to get a job—if the maternal and child health nurse is 35—for 15 years, by which time your certificate will not be really valid. You will not have been able to keep it up.

What disappoints me is that this is another example of Labor going, ‘Aren’t we great? Look what we’ve done; we’ve legislated to get the triple certificate so we can guarantee we’ve got the qualification’, but there is no associated workforce planning. There is no addressing of the challenge we have got to make sure we plan to manage the succession of the nurses through those roles, particularly in the regions. And it is not just the maternal and child health nurses. We have heard it through all the professions. It is an issue in the regions. We need to grow our own and we need to support people in the regions. I have not seen the Labor Party really invest in universities like Deakin where they can give scholarships to young doctors and young midwives to actually encourage them to stay in the regions. There were recommendations from the perinatal care inquiry that would help with workforce planning, and of course there is none of that associated with this—nothing at all. It is all smoke and mirrors.

I will talk about Deakin for a minute. Deakin in Warrnambool does a fantastic job. What they do a very, very good job of is producing some very highly skilled nurses. That is really good for Warrnambool Base Hospital, because it does mean we do have a good, steady supply of staff. It is not so easy for other regional places like Horsham, like up in the Mallee and across in Gippsland, I imagine.

I will come back to the bill and talk about the changes that the government are proposing in this nurse-to-patient ratio amendment bill. I beg the government to recognise that when they make changes they should give the accompanying funds to the hospitals to make sure they can actually employ more nurses and not have to do that by compromising more, say, colonoscopy lists or other services that may be compromised, which we do not want to see. It is a bit of a shout-out here to the good work that Deakin, particularly in Warrnambool, do and the nurses that are produced locally. Good nurses always come from homegrown areas. I was Warrnambool Base Hospital-trained—a good old-fashioned nurse: ‘Make sure your towel’s properly folded’. I just want to also point out that—

Mr Rowswell: Hospital corners.

Ms BRITNELL: Hospital corners. You cannot move your feet. No, you can move your feet—toe-pleats. I do want to also mention that it is very disheartening to have to be standing here and pointing out—and I should also state that we do not oppose this bill, that the Liberal-Nationals have a position of ‘not oppose’ on this bill—that it is still disappointing that it has taken nine years. People say, ‘The government’s busy; we’ve had a pandemic’. Well, no, I have got a fair few friends who now, in our old age, have moved out of the wards—a lot of us—and have moved to the Department of Health and Human Services, and they are frustrated. They are frustrated with being used by this government to play the spin out.

You know we have sat 16 days or 17 days—it will be 18 days tomorrow when we finish—and we will not be back again until August. Really? I mean, I was elected to represent my people in South-West Coast. I am their voice. They tell me what they want, and I say that on their behalf so that we can actually make Victoria a better place. Well, how can I help the Victorians in South-West Coast if I am here 16 days so far and 18 by the time August comes around?

I am sorry, but we have been locked at home for some time. There must be some jobs you need to do; there must be some legislation. And it is our job to scrutinise and to make sure, and sometimes we do oppose things and it is not always what it seems—it is because there are unintended consequences, just like we saw in the original bill, the 35-page bill that I held up before, where the difference between a nurse and a midwife was not understood. I mean, seriously, what if we had not opposed that at the time and stood up for the nurses? You know what, the union actually twisted it around and made out as though we were bad. Well, no—as a nurse I would have been quite horrified that they would have put such a divide between the nurses and midwives, so good on us for doing that. And to stand here with a 13-page bill today and for them to have to have moved a house amendment because it is flawed is nothing short of disgraceful.

I cannot stress this enough: will there be the money that accompanies this bill? And not only ‘will there be the money’ but we have got a budget that has been postponed until October and the Warrnambool Base Hospital needs the money to make the accident and emergency investment and the theatre investment. Now remember—I have said this time and time again in this place—the theatres are very much the same as what they were when I trained at the Warrnambool Base Hospital in 1985. I probably did theatre in 1987. That is a long, long, long time ago. I think the population of Warrnambool was about 20 000; it is nearly double that now, and we have still got the same amount of theatres. Well, I can tell you now, we were doing hips but we were not doing knees. We do knees now. We do much more surgery than we did then. So how are we coping? I will tell you how we are coping. I met with one of the anaesthetists just recently, and do you know what we do? We ring the people who are not actually rostered on. We ring the people who just might be at home—jumped into the garden or whatever—and they come in, because we use the goodwill of our health professionals just like we do with our police.

I recently went into the police station at 2 in the morning to learn what a bail justice does and to actually get a real feel for it. There were police who were there with me at 2 in the morning who should have gone off their shift at 11.00 pm, and I thought, ‘Yes, that is typical’. I worked in the wards for years. I never put in a claim for overtime—it just was not the culture. There would be a cardiac arrest as you were walking out the door and of course you would turn around and run back in and help; you did not just walk past and go home. And that is what the Warrnambool Base Hospital are doing. They have got theatre working more and more hours, and when they have only got one anaesthetist on call after 5 o’clock he is doing things like plastics after hours to get through the list because we do not want people waiting on waiting lists and in pain. We do not want that. The government might not give a rats about it, but let me tell you, the staff in the hospital really do care.

So what happens then when you have got a lady about to give birth who needs an emergency caesar and you have got your anaesthetist tied up? ‘Oh, someone will volunteer’—that is what we do. That is exactly what we do. I mean, if you get a call at 2 in the morning—and you are not on call—saying, ‘We’ve got an appendix; can you come in?’, of course you do. That is just how it works. So we are taking advantage of that goodwill. The government could actually do so much more, but the nurses—just like the police—are used to it. I had not thought about it until just then, but I never ever put in—and I do not think I ever would—a claim for overtime. You just did what needed to be done. People needed you; you did what needed to be done.

So please, government, use that $24.5 billion for our shovel-ready project and build Warrnambool Base Hospital. Give the nurses and the doctors in accident and emergency and theatre the break they need. I do not want to be sensational, but I do know the stress levels are extreme and that is because of the infrastructure they are working in which is so tight and so outdated. I talk to the nurses a lot obviously. I still socialise with my nursing mates. I think there were 21 of us who started, and not too many are actually still on the wards because it is a fairly heavy job. Of those that are, gosh, Katie in theatre does a 10-hour shift on her feet with 10 minutes for morning tea. Your coffee does not even get cold in time to drink it when you are working those sorts of hours.

What I know she would appreciate, I know the surgeons would appreciate and I know the community would appreciate is an investment in the needed—very necessary, it is not a want, it is not a desire because we just want more services that are a luxury to have—basic facilities that need improving. Let us give the Warrnambool Base Hospital the break it needs. They have waited long enough. Stage 1 was completed six years ago. Stage 2 is absolutely beyond need, and it is something I sincerely hope that this government will announce during the October budget.

But in saying that we do not have to wait until October to come back and talk about this a bit more. We can be back during July. I do not think we need a holiday; I think we should be working. That is what we are elected to do. We have been locked at home and we cannot visit our communities. I do not understand the justification for the government to actually take the winter break. I mean, as I said, if there are still flaws in bills, if there are still unintended consequences, if there is still work to do and if it takes them nine years to deliver on a promise and they are sitting less days than in the last Parliament than we had have ever seen in the last century and they are sitting less days than that again this year because of the pandemic—or is that an excuse? From what I can see the federal Parliament still sat, the Tasmanians still sat and the South Australians still sat. So why didn’t we sit? Maybe it was more about gagging, maybe it was more about—

Mr Rowswell: They don’t want to be scrutinised.

Ms BRITNELL: Not wanting scrutiny—that is the one. And we probably saw lots of evidence during the Public Accounts and Estimates Committee inquiry because they did not want to have it. They put it off, they put it off and they put it off. You really do not have to peel back too much of the onion to see the real intent of this government. But I do not think we need to peel back too much at all because what we all just need to do is watch what happened on 60 Minutes and start asking a few questions. We are all busy, so we do not ask those questions and we trust our government. But this current government has evidence that it is rotten to the core, as if that was not evident with our Premier when he sacked a minister just the other day. But that was the second time he had been sacked.

I have employed for years. I employed for 20 years, and I never re-employed someone I had sacked—never. So when he says he did not know, I am finding it really hard to believe. And when we try and put scrutiny forward with the motions that we moved in this Parliament today and yesterday that were blocked, what I see is a rotten government who are rotten to the core with corruption—corruption like I would never have believed I would see in the state of Victoria. I really would have thought that was something we would see on the movies from years ago from parts of the world where corruption is accepted and expected but not here in a democratic country like Australia with a state like Victoria. It is despicable.