Wednesday, 9 February 2022

Bills

Health Legislation Amendment (Quality and Safety) Bill 2021

Second reading

Debate resumed.

Ms KEALY (Lowan) (14:57): I continue my contribution on the Health Legislation Amendment (Quality and Safety) Bill 2021. Before lunch I was speaking to the overall summary for the Targeting Zero: Supporting the Victorian Hospital System to Eliminate Avoidable Harm and Strengthen Quality of Care—Report of the Review of Hospital Safety and Quality Assurance in Victoria. This is a report that was tabled some six years ago now, back in 2016, and I note the former Minister for Health, the member for Altona, is in the chamber at the moment. She did a fantastic job to get this done, but it is a long time since we actually saw this report tabled, which was supposed to make so many differences to improve quality and safety in Victorian hospitals. I note in Professor Duckett’s opening statement that:

In Victoria many health services are working tirelessly … But to a large extent they are doing so with inadequate support from the department, whose approach to safety and quality does not carry the level of attention, investment and priority that the issue requires. The department has inadequate overarching governance and oversight of safety and quality, and is doing too little to lift the capacity of the Victorian health system to improve quality and safety.

I go on:

In many cases the problems with oversight of safety and quality performance in Victoria are the result of budget cuts over the years that have gutted many departmental functions.

If we look back over the past 20-odd years, I think we have had a Labor government now in Victoria for 19 of the past 23 years. For nearly two decades we have had a Labor government, and yet in external reports we see the significant problems within the Department of Health that are related to budget cuts over the years that have gutted many departmental functions. Further in Duckett’s report it states that some recommendations:

… can be implemented quickly (say over 12 months) but others will require legislative or other changes that may take up to three years.

Again, I remind the Parliament this report was finalised and made public in 2016. It is now not three years later, it is six years later, and we are still not seeing action on some of these really important recommendations to improve quality and safety and the experience of people within Victorian hospitals, whether you are a patient trying to access care or the valuable staff that we have working within these systems, so that everybody is protected.

And so what we see yet again is Labor failing to deliver what they say they will. It is always too late, and we do not see the same things applied through legislation and required of external bodies as they do of themselves. During the bill briefing a question was asked around the annual reporting requirement for this new office that is being proposed through this legislation. As I said earlier in my contribution, a lot of this bill is focused on improving transparency and accountability of health services. However, when the question was put, ‘What will be the annual reporting requirements for this brand new department that will be established, the new office of the chief quality and safety officer?’, the response from the department was, ‘There won’t be any annual reporting. There won’t be any reporting of negligence within the hospital system’. It makes me wonder where the level of transparency is when it comes to the requirements that are outlined in this legislation. Are we creating something just so that we can tick a box in terms of the recommendations that were tabled and given to the minister six years ago, or is this about truly improving the quality, safety and experience of patients within Victoria?

Victorians want to make sure that when they call 000 their call gets answered quickly, that when they do call and they urgently need an ambulance because somebody near and dear to them is having a heart attack that that call is logged in the system and they do not have to call back numerous times in order to get somebody to respond and that they are not told that they may have to wait too long to get an ambulance so can they get an Uber or a taxi or can they be driven to their nearest emergency department. People just want to know. Victorians just want to know that health care will be there for them when they need it. They want to know that 000 will be there, that there are enough paramedics and that they are supported to do their job and do it well, that we have got our hospital staff fully supported and that when they go to hospital they will be able to get a bed when they need it and not have to wait for an extended period of time, which could lead into days, in a bed in a corridor or in an emergency department. That is not what Victorians expect, but it is what this state government is delivering for Victorians because the priorities are all wrong. Labor continues to fail to deliver for Victorians.

We also asked during the bill briefing who would be covered by this—whether hotel quarantine, for example, would be covered by the regulations and the requirements within this bill. It was confirmed that the medi-hotels would be included in the requirement for a duty of candour and governance under the chief quality and safety officer. In addition to that we asked about the medically supervised injecting centre because that is linked to and governed by North Richmond Community Health. Yes, it will come under this as well. Again I hope that there is some review of the level of reporting that is undertaken by this brand new department, because we want to make sure there is true transparency and that means accountability and transparency to the public and not keeping the bad news secret, which is outlined completely in Duckett’s report. But it has taken Labor six long years, and in their final months of this term of Parliament they are seeking to bring it through and form legislation from it. We need to see these changes soon, but we need to make sure they are done correctly.

There is another element of this that I flagged in the bill briefing that I had concerns about. That is that it is still not altogether clear whether this will impose an additional regulatory burden upon health services in Victoria. Already health services have to meet so many requirements when it comes to reporting and adhering to quality and safety standards, and there are also regular audits. It might be a drop-in visit, a surprise audit or a spot audit. It may be something that occurs on a periodic basis. It may be something that occurs annually. Having been the CEO of a hospital, I know how heavy things were in terms of the obligations for us to report to public bodies, whether it was the state government or the federal government or all of the accreditation bodies that we had to perform under. There are the aged care standards and the national standards that have to be met. If you have a GP clinic on site you have to meet Australian General Practice Accreditation Limited standards. You also have other burdens that you have to meet, including the oversight of the health complaints commissioner and the aged care complaints commissioner. You have also now got Safer Care Victoria. We also have financial reporting, whether it is through an external auditor who comes in on an annual basis or the Auditor-General’s office. In fact it is a very, very big job when it comes to managing auditing and compliance requirements within the health sector.

I completely understand the need for mandatory reporting, because the best way to get better at what you do is to understand what does not go well. If it was a near miss, if it was an event, whether it was a serious or a sentinel event, you have to go back and review what happened, what went wrong and what you can do differently to make sure that this does not occur again. But it is becoming so burdensome for our health systems that a lot of the block funding or the set funding that is provided to them from the state government is allocated now to compliance and reporting as opposed to delivering patient care. While I think everybody would accept that there is a requirement to ensure we have appropriate governance when it comes to quality and safety in our health services, hospitals need to be provided adequate funding to be able to deliver that without compromising patient care and without being put in the position of, ‘Well, do we put our money that is provided by the government towards compliance to make sure we can keep our doors open and that we don’t get into trouble and breach legislation, or do we choose to enhance our maternal and childcare services or perhaps engage a physiotherapist or look at investing into our infrastructure and buying new beds?’. Bariatric beds are rarely funded by the government nor is other bariatric equipment that is required more and more frequently in Victorian hospitals. It could be about getting another vehicle on the road or getting more and up-to-date equipment into our ambulances. That is what the question comes down to for our administrators of the health system: where do we spend our money?

So I absolutely understand the intent of this legislation. However, I do ask the government to consider, rather than adding another layer of bureaucracy, another cost burden to our health services, another administrative burden, actually looking at streamlining some of this, because not only will that result in a more efficient health system where money is spent delivering the care that Victorians need and deserve, but it will mean that we will have a stronger framework, that there will not be as many opportunities for instances to be missed or for things to be duplicated to a point that people do not take it as seriously because they see it more as something they have to do rather than something they want to do to engage in that continuous improvement, which is really the mantra within every single health service that I have ever set foot in in Victoria.

Other aspects of this legislation specifically focus on extending protections for apologies offered by health service entities for harm suffered by patients. Now, this is an important element because if there is a serious or sentinel event which causes, particularly, harm to individuals when they are engaging with the health service—and nobody expects to have harm done to them when they go to a health service; you expect to get better and not get worse—it is an important part of the healing process for many individuals and loved ones who are exposed to harm in Victoria’s health services that they have the opportunity to understand what happened to them, but more importantly, that they have the opportunity to gain some level of closure, to hear those vital words, ‘I’m sorry this happened’, to receive some level of consolation that steps have been taken to review the root cause of the incident and to understand then what changes have taken place to make sure it does not happen again.

Now, from my experience in all aspects of the health system, I have always seen that the organisations I have worked with have taken that extraordinary seriously. At every step, and I have worked in the private and public sector, there have been serious steps taken in terms of effectively communicating with the individual and the family members to make sure that it is done in an open and transparent and extraordinarily honest way, because the best way to get to the understanding of what risks caused that incident to take place is only achieved through transparency, openness and honesty. I strongly support what is already happening with the healthcare system. I strongly support the steps that are being taken, in particular by staff to do the right thing, but we also need to make sure that they are given the support from the department to do the right thing. As I stated earlier, in the Duckett report back in 2016 he emphasised that public health services were not getting the support they needed from the department. He specifically outlined the failures of the department. I think it is really incumbent upon the health department to spend more time on that, making sure that rather than getting a list of things that hospitals must do, they actually embrace hospitals and provide more guidance and support and helpfulness in terms of delivering improved outcomes for individual patients, and that is exactly what Professor Duckett has called for.

The state of Victoria’s healthcare system is probably not great at the moment. It is particularly bad, and that is not just because of COVID. We all know that there has been COVID for the past two years—how could we avoid knowing that?—but this started to happen well before the COVID pandemic hit. We are seeing terrible incidents and wait lists growing right across the state. In relation to this bill and talking about sentinel events, tragically Victoria’s public hospitals recorded 24 incidents of avoidable serious harm or death to a patient—the second-highest reporting state being New South Wales with just nine reported incidents. So in Victoria there were 24 incidents over the period, whereas New South Wales, the next in line, had only nine incidents. Now, any incident is terrible, and nobody wants that to occur, particularly the staff who are involved, because there is a terrible burden of guilt when it comes to a tragic incident occurring while somebody is within your care, but to think we have had 24 incidents in one year in Victoria, 2½ times the number in the next state on the list, is really devastating and just shows what a terrible state health care is in in Victoria.

We also note that less is being spent per person in Victorian public hospitals than anywhere else in the nation, with Victoria spending $2687 per person, well below the national average of $2971. This is something that is not unique to health. We are also seeing the same focus in mental health, which is extraordinarily low and has for many years had the lowest funding per capita in the nation. We have also seen the same problems with rehab beds, with hundreds more beds in New South Wales for residential rehab than there are available in Victoria.

While I note that there are many government members who are groaning at the moment and unhappy about it, do not groan to me about it because you have got responsibility for it. You have got the Minister for Health there. I know the Minister for Agriculture is now talking about cuts to ag funding, but I note in the Targeting Zero report that there is actually a reference in there from Professor Duckett that it was a Labor government that cut the funding and devastated the support of the departments in relation to supporting our public hospitals to deliver the best possible health care and the best possible standards of quality and safety that are available.

Mr Dimopoulos interjected.

Ms KEALY: I am more than happy to table the report if the member for Oakleigh has not seen it. I quoted it earlier if the member would like to pay attention, or perhaps, Acting Speaker, you would like to ask the member to stop interjecting.

The ACTING SPEAKER (Ms Suleyman): Order! Member for Lowan, continue, please.

Ms KEALY: Thank you very much. I will refer to this report, Targeting Zero—I referenced it earlier, I read it into Hansard. I am more than happy to send a copy to the member for Oakleigh if he has not yet had the opportunity to read through it, because there is a lot of information in there that will give the government a template to actually focus on improving health outcomes and delivering for Victorians rather than just delivering a message, which they never see through, to make a difference to Victorians.

This data that I am referring to is from the Report on Government Services, the report on government statistics. That was released last week, and these are the key points out of it. This is very important. It is highly respected data, and it shows that in Victoria we have an atrocious health system. While current government MPs might like to point the finger at anyone other than themselves, they have been in government now for seven years. They have been in government for 19 of the past 23 years. I note the Acting Speaker’s eye roll, but that is the case that we have got in Victoria.

The ACTING SPEAKER (Ms Suleyman): Excuse me. My contact moved if that is okay—so withdraw that.

Ms KEALY: Thank you very much. I will note that and retract that. However, it was noted at the time that the commentary from government MPs involved eye rolling as well.

The statistics that came out of that: in the year 2020–21, 38 per cent of designated emergency patients arriving in emergency departments were not seen within the national benchmark—a 5 per cent decrease from 2019–20. In 2020–21, 44.9 per cent of category 2 patients on the elective surgery waitlist had their wait periods extended beyond the recommended 90 days. In comparison New South Wales only saw 4.3 per cent of cat 2 patients face a wait time over 90 days. Now, just for comparison, that is 44.9 per cent waiting more than three months in Victoria and only 4.3 per cent in New South Wales.

I refer back to the case of this lovely family I met in my electorate last week—Tiana and Billy and their gorgeous little boy, Malik. Their son desperately needs cleft palate surgery. He desperately needs it. The ideal time for cleft palate surgery is between four and six months of age. His parents do not know when Malik is going to be able to get his surgery, and if he does not get it soon, it will mean worse outcomes for this darling little boy. It means that he may have more scarring. It means that his hearing may be at risk of permanent damage. It means that he may not develop in the same way that he would if he was able to access that surgery, so I again implore the government. There was some common sense seen when it came to reversing the bans on IVF. That happened very, very quickly. It was seen as an elective procedure early on. There was a review of it because there was community outrage and people could not believe that you would put something as important as having a baby on indefinite hold. But we have got the same situation here with these babies who have only a limited window of time for the optimal, best outcomes for them to get their cleft palate surgery, and I urge the minister to review surgery for those little kids.

I have gone over a lot of the key points, particularly around transparency of government and the transparency that is involved in this. The duty of candour will be very, very important for many people who want to hear those precious words of ‘I’m sorry’. I do encourage the government to take on the proposed outcomes of this legislation to improve transparency when it comes to health care and other matters, because it is so important that the Victorian community understands why decisions are being made.

Mr J BULL (Sunbury) (15:17): I am pleased to have the opportunity this afternoon to make a contribution on this important piece of legislation, the Health Legislation Amendment (Quality and Safety) Bill 2021. That was quite an extraordinary contribution from the member opposite. I think one of the lines was ‘an atrocious healthcare system in Victoria’. I am going to leave those comments over on that side of the house. Instead I want to acknowledge and thank the incredible work of all of those healthcare professionals that work in my community and—

Ms Kealy: On a point of order, Acting Speaker, I ask the member to withdraw the mischaracterising of what I contributed. I congratulated and thanked the healthcare workers on many, many occasions, and to have my words that Victoria’s healthcare system is in a disastrous state in any way reflect that I do not respect healthcare staff is extraordinarily inflammatory, and I ask him to withdraw.

Ms Thomas: Acting Speaker, on the point of order raised by the member on the opposite side, there is no point of order. There was no direct reflection on the member, and I ask that you take that into consideration.

The ACTING SPEAKER (Ms Suleyman): On the point of order, at this point I am ruling that there is no point of order. A point of order or a ruling on debates is really not relevant at this point.

Mr J BULL: Thank you, Acting Speaker. I do want to take the opportunity to thank all of those within my local community and communities right across the state, within the city, within the suburbs, within rural and regional Victoria, who do an outstanding job. Whether they be ambulance officers, our nurses, our doctors, the clerical staff, all of those that work within hospitals and local community health do an outstanding job each and every day, particularly over these past two years as we have discussed quite a lot today with this morning’s motion and a whole range of other matters that have come through the house this afternoon. This has been an incredibly tough, an incredibly challenging and a very hard period within our history as a state and also the history of the nation.

This has been, as you know, Acting Speaker, dealing with the COVID-19 pandemic, an incredibly challenging time for our healthcare professionals. This bill had its origins, as has already been mentioned, quite some years ago, so I do want to take the opportunity to acknowledge the work of the member for Altona in her time as the health minister, which is when many of these matters were canvassed. Knowing and understanding the particular challenges that are experienced within the healthcare setting, I just want to put that on record.

We know that there is nothing more important than the health of our community, the health of each other and the health of our state. As has been mentioned, the past two years—a global pandemic—have been particularly challenging with new variants coming through the door and a response that has required the entire Victorian community to collectively come together right across all sectors, not just in the healthcare setting, to work together to be able to combat the impacts of COVID-19. We know that the healthcare system is made up of proud men and women who serve local communities each and every day. As I have said, I certainly want to put on record my thanks for and acknowledgement of their work.

I want to get to quite a few specifics that are contained within the legislation this afternoon, but I do also want to mention the significant contribution, the $1.4 billion contribution, announced just a couple of weeks ago that goes to supporting our doctors, our nurses and our paramedics: the $938 million allocation to be shared across Victoria’s public hospitals, $225 million to ease pressure on hospitals and ambulances, $196 million to expand the COVID-positive pathways program, $21 million to implement the statewide virtual triage service and $8 million to fund additional GP and respiratory clinics and five urgent care centres. Acting Speaker, as you know, local health care is particularly important—extremely important within the suburbs, extremely important within rural and regional Victoria—and something that certainly goes a long way to making sure that we are supporting our local communities.

This piece of legislation is designed to improve the quality and safety of health services in Victoria and facilitate more person-centred and accountable services by increasing Safer Care Victoria’s ability to identify and assess quality and safety risks and support remediation, mitigation and improvement where risks are found; encouraging and facilitating full and frank participation and candour, which I do know the previous member mentioned; and of course the comprehensive review process to drive continuous improvement of quality and safety. It is also designed to help foster an open and honest culture in health services by elevating obligations for open disclosure, candour and apologies, and ensure that the Victorian Perioperative Consultative Council has requisite independent powers and protections to operate effectively to reduce our perioperative mortality rate.

Many of the elements contained within the legislation build upon the work that was done in 2016 on the Targeting Zero report when it was released, led by Dr Stephen Duckett, involving reviewing hospital safety and quality assurance in Victoria. I do want to acknowledge the 11 cases of preventable perinatal death at Djerriwarrh Health Services in Bacchus Marsh, and for each of those tragic deaths I send my deepest condolences to the families, loved ones and all individuals involved. We know that the work that has been done to bring this legislation before the Assembly this afternoon builds upon the work from 2016 and the work that was done after public consultation by the expert working group in 2018, which was appointed to advise on legislative reforms arising from the Targeting Zero work, and we know that the government accepted in principle all 179 recommendations.

The key features of the bill, which I know have already been mentioned, of course continue to deliver on the recommendations of the Targeting Zero report, some of those including the statutory duty of candour. Being an Australian first, the duty will be established to ensure that any person who is harmed while receiving care from a health service entity is informed of this and receives an apology from an appropriately trained professional on behalf of the health service, which is consistent with the Australian Commission on Safety and Quality in Health Care’s Australian open disclosure framework. Amendments to the Health Complaints Act 2016 will also include provisions for a person to make a complaint to a health service provider which has failed to comply with the statutory duty of candour in respect to themselves or another person. Carers can also make complaints to the health service provider of unreasonable treatment of the carer in the course of failing to comply with the duty of candour. We know that there are a number of different provisions, amendments and changes that are contained within this legislation which go to quality health care within our community, and if you look at many of the policies, many of the projects, many of the initiatives that have been delivered and continue to be delivered by this government, we know that quality local health care is incredibly important.

This is a bill that surrounds particularly health, but if I draw on some of the recommendations that were contained in the Royal Commission into Victoria’s Mental Health System and the significant allocation, the historic allocation, that was provided by this government, we know of course that one of the key findings and one of the most important recommendations within that report was to be able to find early intervention and to be able to provide local support when and where you need it. We know that this is a critical principle within mental health—we know that this is a critical principle within health—but what this piece of legislation does this afternoon is ensure that we are providing a system of health care within this state that puts patients first, that works extremely hard to provide many of the safeguards and that increases quality for patients. We know that this is fundamentally important to the entire journey of those who experience our healthcare system as they traverse through the many challenges that exist. I commend the bill to the house.

Ms STALEY (Ripon) (15:28): I rise to speak on the Health Legislation Amendment (Quality and Safety) Bill 2021, and as the member for Lowan, our lead speaker on this bill, has indicated, the opposition does not oppose this bill. I want to make some remarks about the bill and then also some remarks about health services across Ripon. In fact I might start there. Ripon is fortunate to have quite a large number of health services servicing our population, and they do amazing work, over the past two years of the pandemic in particular. I want to pay tribute to the many, many nurses who have stood out in both the cold and the heat of western Victorian winters and summers in the testing stations and also those who have run the vaccination clinics at many of these health services. They have done and continue to do a great public service to the people of my region, and I thank them wholeheartedly for everything that they do and they continue to do.

It is also true that my health services more broadly are supporters of a collegiate model. Now, some have gone the full merger, and communities have had quite a bit to say about that, but we have had several others that absolutely support the regional health service, which is Ballarat Health Services, in backing up their surgery lists, and they are telling me that they are ready, willing and able to restart elective surgery. They have the capacity to do so and they have organised themselves in a way so that they are ready to do that. The government really could take note of that and get on with restarting those important elective surgeries.

This bill that we have before us today the government says is the last piece of legislation that comes out of Targeting Zero: Supporting the Victorian Hospital System to Eliminate Avoidable Harm and Strengthen Quality of Care. Now, it would need to be the last piece of legislation, can I say, because it is already several years late. That report came out in 2016, and the author is Peter Duckett.

Ms Kealy: Stephen Duckett.

Ms STALEY: Stephen Duckett, sorry. Peter is the management guru. Stephen Duckett is of course the Victorian health policy expert. One of the things that he said in his introduction was that:

Many of our recommendations can be implemented quickly (say over 12 months)—

that was his phrase—

but others will require legislative or other changes that may take up to three years.

Well, this report is a 2016 report, and we are well past the three years. The government cannot even argue, ‘Oh, well, there was a pandemic in the middle’, because they should have done them in 2019 before the pandemic. Before the pandemic came they were meant to have done these, but they had not. They had not acted on this important report, which of course arose from some tragic events at Djerriwarrh Health Services. I would have thought—

Members interjecting.

Ms STALEY: Look, the member for Buninyong is out there screaming at me. I cannot actually tell what she is saying; she is just screaming.

Members interjecting.

The ACTING SPEAKER (Ms Suleyman): Order, members.

Ms STALEY: As if she actually knows something about this. As if she knows! It is entirely her government that has been lacking in this space.

The ACTING SPEAKER (Ms Suleyman): Member for Ripon, through the Chair.

Ms STALEY: It is entirely her government. In fact clearly the member for Buninyong, and perhaps others on that side of the chamber, have not read the Duckett report, because I will just remind them what it says.

Members interjecting.

The ACTING SPEAKER (Ms Suleyman): Order! Member for Ripon, through the Chair. Members, thank you.

Ms STALEY: What the Duckett report says is that:

… the problems with oversight of safety and quality performance in Victoria are the result of budget cuts over the years that have gutted many departmental functions.

He also says that to a large extent the health services are working tirelessly, but they are doing so—and this is in the present tense, 2016, member for Buninyong—

… with inadequate support from the department …

The ACTING SPEAKER (Ms Suleyman): Member for Ripon, through the Chair.

Ms STALEY: I do think that those on the other side protesteth too much, because of course it is the Labor government—it is this Labor government—that is presiding over the lowest funding per capita in Australia. The lowest funding per capita. Acting Chair, I am sorry, she should really—

The ACTING SPEAKER (Ms Suleyman): Is there a point of order?

Ms STALEY: Bring the member for Buninyong to order.

The ACTING SPEAKER (Ms Staley): I have already reminded members.

Ms Kealy: On a point of order, Acting Speaker, the member for Buninyong continues to disobey your order. It is completely inappropriate to have any member of this place abuse somebody and yell at them consistently, for minutes now. I ask you to do your job and listen and do something. I am not meaning that disrespectfully, but you have a responsibility to keep order in this place. We are getting screamed at repeatedly. I ask you to bring the member to order.

Ms Settle: On the point of order, Acting Speaker, I do not think that it is appropriate to reflect upon the Chair in this chamber, and I would like you to call the member for Lowan to order.

The ACTING SPEAKER (Ms Suleyman): Thank you. I just remind all members it has been a lively debate, and it has been pretty free and wideranging on both sides. So can I ask the member for Ripon to continue.

Ms STALEY: Thank you, Acting Speaker. It is clear that the government is embarrassed not only by the fact that they are presiding over a clearly identified failure in safety identified by the author of their own review that they did but that they then took many years longer to legislate on these important safety improvements. And now we are being told that it is not a resource problem, yet that is exactly what Duckett identified in his report.

And the Productivity Commission has just this year reaffirmed that in fact it is the Andrews Labor government who has the lowest per capita funding of health of any government in Australia—the lowest in Australia. Every time members of the government stand up, they try and say that they are really supporting health. I note that the sort of language they use is about building new hospitals, and yes, that is important, but so is staffing them. We know that from the Premier’s boast that he would put in 4000 new ICU beds for the pandemic, and then they did not appear, because they could not be staffed. They never were delivered, because they could not staff them. That would be because this government underfunds health. Day in, day out they underfund health, and they try and pull the wool over the eyes of the Victorian people that they are doing the right thing when every day they are not. Every day they are mismanaging this health system. They are leading to poorer patient outcomes, and quite frankly they are completely misleading—I was going to use an unparliamentary term—the Victorian people when they say things like they will provide 4000 new ICU beds and then they do not.

It is actually a pattern of behaviour here that goes right back to Stephen Duckett’s report, which is the basis for the legislation we are now debating. He said that there was ‘inadequate support from the department’ and there was not sufficient ‘attention, investment and priority that the issue’—that being patient safety—‘requires’. At every turn here this government is failing Victorians when it comes to the health system. We have elective surgery still closed down in almost all circumstances. We do not have the ICU beds that we were promised. We have a highly delayed, years delayed, response to a patient safety report, and then when they do so they are creating yet a new bureaucracy—the office of the chief quality and safety officer—but that office has no requirement to annually report, so we still will not know. At every level this government is failing the health of Victorians.

Mr McGHIE (Melton) (15:38): I rise today to contribute to the Health Legislation Amendment (Quality and Safety) Bill 2021. Public health and wellbeing is something that we have been well aware of over these last few months and years. Health is something that this side of the house takes very seriously, and that is why the Andrews Labor government acted so swiftly when it needed to, following the discovery of a cluster of tragically avoidable perinatal deaths at Djerriwarrh Health Services in Bacchus Marsh. This was a tragedy that still resonates in my electorate, and I know that many people and families have suffered through this tragedy.

This bill represents the final stage of the legislative reforms arising from the 2016 report Targeting Zero, and the review of hospital safety and quality assurance in Victoria led by Professor Stephen Duckett has been referred to in previous contributions. The Targeting Zero review provided us with a detailed and extensive analysis into how the Department of Health oversees and supports quality and safety of care across the Victorian health system. It also captured the views and experiences of patients, clinicians, hospital managers and boards about how to make Victoria’s healthcare system safer.

Certainly there were gaps and failings in quality and safety systems highlighted, as well as the need for action and leadership to achieve change and prioritise patient safety. On 14 October 2016 the Minister for Health committed in principle to adopting all the recommendations from this report, including those which require legislative change. These reforms are the most significant overhaul of Victoria’s health system in decades.

I would like to take a moment here to thank the former Minister for Health, the member for Altona, who I believe will follow on with a contribution after me, for her compassionate and decisive leadership through that terrible time and a very difficult time for all those involved. I look forward to her contribution later on today.

I would also like to acknowledge the Minister for Women, the member for Dandenong, in her former role as Parliamentary Secretary for Health for her leadership with the expert working group in the consultations with health service providers, regulators, unions, professional associations and others.

I acknowledge the great contribution from my colleague, the member for Sunbury. I want to also congratulate him on his new appointment to the role of Parliamentary Secretary for Health, and I look forward to working with him in that role. I pick up on some comments he referred to from the opposition about an ‘atrocious healthcare system’, and I remind the opposition that that was your attitude in your last term, between 2010 and 2014, towards healthcare workers, and in particular my members at the time, the paramedics across Victoria. I remind you that attitude is the reason why you are sitting in opposition today.

The expert working group appointed by the then Minister for Health to advise on legislation reforms arising from the Targeting Zero report recommended a high-level duty of candour law where health services must apologise to any person harmed while receiving care and explain what has gone wrong and what action will be taken, complementing existing requirements under the Australian Commission on Safety and Quality in Health Care’s open disclosure framework—also statutory protections for apologies and serious adverse patient safety event reviews, as are currently in place in New South Wales, South Australia and Queensland.

So what is a duty of candour? Well, it is a requirement that the health service entity has an open disclosure to provide patients impacted by a serious healthcare incident with the facts about what occurred, an apology, a description of the health service entity’s response and the improvements being put in place following the incident. I think that is all people look for right across all points of life: that is, when things go wrong we want an explanation, and if an apology is required then that should be forthcoming. In the past there have been some reservations about providing an apology in the healthcare sector, out of fear of legal repercussions. Patients and their loved ones want an acknowledgement if things go wrong; it is important not just for physical recovery but especially for emotional and mental health and wellbeing. We can often get too caught up in the legalities and the terminologies. Patients receiving care that experience an issue simply want to know what went wrong, what is being done to fix it and preventions for it occurring again—and certainly they want an apology. In many cases that can be the end of the matter.

I know from my experience as a paramedic that healthcare providers are not immune from making mistakes, but our response to that is critical and important. There are always cases where you know you could have done better. I know in my experience as a paramedic that you do not always get it right. There are circumstances that lead to that, and you know when you go over that case and analyse what you did that things could have been done better. No-one goes out to deliberately harm a patient. All healthcare workers have the patient at heart.

Since the release of the Targeting Zero report, the Victorian health system has improved on quality and safety monitoring, clinical governance and reporting. Of the 179 recommendations significant progress has been made on almost every recommendation, and well over 70 per cent of these have been 100 per cent completed. Previous legislative changes arising from the report were implemented in the Health Legislation Amendment (Quality and Safety) Act 2017, and information-sharing provisions were implemented and included in the Health Legislation Amendment and Repeal Act 2019. One of our leading surgeons, Professor David Watters OBE, said in response to the Targeting Zero report:

Victorians should have confidence in the fact that they have access to one of the best and safest health systems in the world.

Implementing the recommendations of the Duckett report across the state will reduce adverse events and avoidable harm, their incidence will be on a trajectory towards zero

That is quite different to what we have just heard from the opposition about an ‘atrocious healthcare system’. I am proud that this bill will result in the further implementation of recommendations from the Targeting Zero report, strengthening the role of Safer Care Victoria to drive statewide improvements and achieving the important balance between transparency, accountability and protections to prevent harm through robust quality and safety reviews. These reforms will make Victoria the first jurisdiction in Australia to introduce a duty of candour law as well as introducing protections for patient safety reviews based on models already in place in Queensland, New South Wales and South Australia.

Our hardworking nurses, doctors, paramedics and other healthcare workers provide all Victorians with high-quality care and, like everyone else on this side of the house, I send my thanks to healthcare workers for their efforts during the pandemic. We know there is always more that can be done, and this bill will ensure that in those few instances when something does go wrong patients will always get the answers they need and lessons will always be learned. A quote in the report says:

‘the open, honest, and timely disclosure of medical error to patients … is ethically, morally, and professionally expected of clinicians … [it] should be a “no brainer”’.

The expert working group appointed to advise on Targeting Zero consulted extensively on the introduction of the Australia’s first statutory duty of candour in Victoria. The consultations revealed a significant appetite in the health sector for greater transparency and a strong belief that members of the Victorian public are entitled to it.

I want to go to one last point before I finish my contribution. I will just say that in this time of COVID and the pressures this pandemic has placed on our health system it is important that we have systems in place to improve and maximise its potential. I am saddened that, as this pressure has been placed on our wonderful healthcare professionals, some have chosen to play politics through this difficult time. I was made aware recently that in my electorate of Melton the Leader of the Opposition called for a health crisis forum and actually conducted that forum last Thursday in Melton. Thankfully the constituents of Melton are smarter than the cheap politics and only 21 people turned up. Honestly, I think I could get more people to a card game than a health crisis forum. The constituents of Melton are also more intelligent than the opposition. They know that this Andrews Labor government is delivering a new hospital in Melton, whilst the Leader of the Opposition claims the government does not even own the land. You would think that a former planning minister would grasp the concept of a notice of acquisition published in the Victoria Government Gazette. It just goes to show you that he cannot be trusted on health care or on planning.

A goal of zero avoidable harm is an ambitious target, but one we have an obligation to do everything we can to achieve. World-class care must be matched by world-class quality and safety systems, and that is exactly what the reforms in this bill will help deliver. I support these amendments, and I commend this bill to the house.

Mr D O’BRIEN (Gippsland South) (15:48): I am pleased to rise to say a few words on the Health Legislation Amendment (Quality and Safety) Bill 2021. I also begin, as others have done, by thanking the healthcare workers of our state that have done a magnificent job over the last couple of years. I will include and acknowledge the past history of the member for Melton as a paramedic in our state and the good work that he did. I hope he was a much better paramedic than he is a politician because he has just basically suggested that the notion of a health crisis in Victoria is a fallacy made up by the opposition. The member for Melton should look at some of the statistics, look at some of the cases. He should have been paying attention in question time over the last few days as we have reeled out case after case of people who are struggling with the way the health system is being managed at the moment. I am going to go into some detail in a moment on the report on government services that highlights what a failure our current health system is under this government. This government has been in power for what is it—18 of the last 22 years? The health system has been run by a man who has been either the Premier or the Minister for Health for 11 of those years and we have some significant issues.

That brings us to this legislation. The opposition will not be opposing this legislation, but the more I look at it the more I really question this government’s attitude and motives, process and policy when it comes to not only delivering health care but delivering government in this state, because this is the establishment of yet another new government bureaucracy—a new authority, a new commissioner, a new officer. This happens every time. There is not a problem that afflicts public policy in this state where this government does not see the solution as being yet another government agency. Whether it is the school building authority—I thought the education department built schools—whether it is the level crossing removal authority, the Suburban Rail Loop Authority, the North East Link Program authority, we constantly have a new authority every time. Whenever the government has a new policy idea there is a new authority established for it, and you wonder what some of the departments are left to do because they have got these new authorities being set up left right and centre. And of course we know what happens with each of these authorities: there is a CEO and a deputy CEO and a media team and a comms team and so there are more and more jobs in there, and we have just heard in the other place actually how this government has been stacking those jobs with Labor Party friends.

Anyway, this is the establishment in principle of a new chief quality and safety officer under this legislation. That in itself sounds appropriate. I look at it and I think that we have already got the health complaints commissioner in Victoria, we have already got Safer Care Victoria here in Victoria, we have got numerous other agencies, like the Aged Care Quality and Safety Commission at the federal level, and I do really wonder what it is that we need yet another new officer for. Now, the government will say, ‘Well, those agencies don’t have the power to do the work, particularly what is proposed under this legislation, particularly looking at private hospitals’. Well, why not give one of those existing agencies that power under this legislation? What is the purpose of establishing a whole new system, a whole new bureaucracy, under the chief quality and safety officer? None of us in this place will argue that there is not a need to ensure that bad events, adverse events, in our hospitals and health system more broadly are investigated and that there is a process particularly for patients and their families, but why the need for a new agency all the time? It just beggars belief.

So the new chief quality and safety officer will have a role to conduct quality and safety reviews of both health and ambulance services, and there is also—and it is one of the issues that is being promoted—the new duty of candour that requires health and ambulance services to inform patients and/or their families when harm has occurred to a patient during their treatment and also requires them to apologise to patients or their families for any harm that does occur. We all understand that in any system and any health system there will be occasions of adverse events, and as members of Parliament I am sure we all get those concerns raised with us. Sometimes people come to me directly. Sometimes they have already been to the hospital or the health service and are not happy with the response they get. Sometimes we simply refer them to the health complaints commissioner or to Safer Care Victoria or indeed to the minister. There will always be issues, and it is appropriate that where there is fault, and there will be fault from time to time, even in the closest to perfect system, there is an apology, and often that is all that the patient or the family members of the patient want. They acknowledge something could go wrong, but they just want an apology. So I do not have any issue with that, but as I said, what concerns me is that at a time when our health system is under enormous duress—and it is not just duress caused by the pandemic, it is duress caused by management or mismanagement of the system for some time—we are introducing this legislation with yet another chief quality and safety officer, another bureaucracy.

This is in the context, as others have mentioned, of the recent release of the report on government services (ROGS) by the Productivity Commission. We see in that report a number of tables, and it makes for quite illuminating reading for any Victorians who would like to compare us to the rest of the country. For recurrent expenditure per person on public hospital services for 2019–20 Victoria is eighth on the list of states and territories at $2687 per person compared to the top end, Northern Territory—clearly a higher cost—at over $6000. But the national average is $2971, and Victoria is well under it. New South Wales is $2887—our nearest competitor, so we are considerably behind. Now, in some respects that would be good. If it was that we were efficient, if we were delivering better services for less money, that would be great. I would be the first to applaud it. But when you look at some of the other statistics, that is not necessarily the case. For available beds per thousand people, for example, Victoria is seventh on the list of the eight states and territories at just 2.3 beds available per 1000 people versus New South Wales, our nearest competitor, at 2.6.

Emergency department waiting times—again we can say, ‘There’s been a pandemic’. Well, everyone has had the pandemic. In 2020–21, if you compare our performance in the ROGS data on emergency departments on the percentage of patients seen on time with New South Wales—again our nearest competitor and the one that we need to be comparing ourselves to—for ‘Resuscitation’, those seen on time is 100 per cent for both New South Wales and Victoria. Under ‘Emergency’ Victoria is 17 percentage points lower than New South Wales. In the ‘Urgent’ category Victoria is 12 percentage points lower than New South Wales; in ‘Semi-urgent’, 7 percentage points lower than New South Wales; in ‘Non-urgent’, 5 percentage points lower than New South Wales; and in total, 11 percentage points lower than New South Wales.

Elective surgery is an issue. I started on that and I will continue on it. We have seen the most recent data from this state. We are now up to over 80 000 people on that elective surgery waiting list, and we are still waiting for the government to actually give the okay to fully resume elective surgery in this state despite the fact that the number of people in hospital with COVID has come down considerably in the last couple of weeks.

The ROGS data has ‘Turnover following admissions for surgery’—so basically how many people were added to the hospital waiting list in a year and how many were removed following surgery—and that is following surgery, not just people being taken off the list because they died or whatever happened, but actual turnover. Again, out of eight, Victoria is at number six, with 80.9 per cent actual turnover per annum for elective surgery, compared to New South Wales at 93.4 per cent. So I have got to hand it to this government: we have got regular claims of record spending on the health system and we are constantly told how much focus this government puts on the health system, and yet we have got a health system that is underperforming compared to all of our competitors around the country.

I think the member for Lowan talked about this: the final one I just want to touch on from the ROGS data is ‘Sentinel events’—that is, effectively serious events, in particular causing death or very serious injury, where something went wrong and was caused by the health system—the public hospital in this case. For 2019–20 there were 24 such events in Victoria versus just nine in the next biggest one, New South Wales. There were eight in Queensland, and it was lower in all the other states. Yes, that is a one-off year—the data does not show me the previous years—but it is a significant concern. We do not oppose this bill, because it is important that we have these oversights in our health system, but I do wonder why existing facilities cannot do what they are supposed to do.

Ms HENNESSY (Altona) (15:58): What vainglorious hypocrisy we have seen from the opposition in the course of their contribution to this debate. It was only in question time today that we saw their flummoxed attempted attack on the government as they asserted that our public sector was too small in Victoria, and now here today in the course of this debate the criticism is that the public sector is too large and that we do not actually want to establish the sorts of bodies that will put the right checks and balances on quality and safety in this state.

I had the very moving responsibility of identifying a very significant problem at Djerriwarrh Health Services, where I was supported by Professor Euan Wallace and subsequently Stephen Duckett in rebuilding a proper model of quality and safety in this state. Do you know why we had to rebuild it? Because it had been cut under the previous government. They had cut quality and health and safety in the department of health. It was very clear, and that is what was referenced in Mr Duckett’s report. Do not let the facts get in the way of a good political debate. To have the opposition come in here and attempt to attack the government for rebuilding Victoria’s health system is a fallacy that I will not allow to go uncontested. The story of health and safety in the state of Victoria is one in which governments have taken leadership, where we listen to our workforce, because our greatest partner in building a high-quality, safe health system is in actually supporting the workforce—not by trying to sack nurses and paramedics in the state, not by closing and privatising the health system but by actually working with your staff.

Business interrupted under sessional orders.