Wednesday, 9 February 2022

Bills

Health Legislation Amendment (Quality and Safety) Bill 2021

Second reading

Debate resumed.

Mr R SMITH (Warrandyte) (18:00): I rise to speak on the Health Legislation Amendment (Quality and Safety) Bill 2021. In doing so I would like to immediately draw the house’s attention to the second-reading speech given by the Minister for Health, with the introductory line:

Victorians should have confidence in the safety and quality of our health system.

I think that we would all agree with that. Certainly on this side of the house we would agree that Victorians should have confidence in the safety and quality of our health system, as the minister has put forward. The problem is that Victorians do not have any confidence in the safety and quality of our health system simply because under Labor’s watch it has fallen apart. With elective surgery waiting lists at record levels—they have never been at these levels; 80 000 people languishing on those elective surgery waitlists—you would have to say that we are in nothing short of a health crisis, and it is worth considering why that is happening.

If I can take this house back to the period of the coalition government, 2010 to 2014, the member for Doncaster at the time, the Honourable Mary Wooldridge, was commissioned as the Minister for Mental Health. I think you would be hard-pressed to find any stakeholders, or indeed those opposite, who would have too many criticisms of the way Ms Wooldridge handled that portfolio. With the coming in of the Labor government in 2014 the member for Albert Park was commissioned as the Minister for Mental Health. Within a few short years the government declared the mental health system broken, in fact so far broken that they said that there would be a royal commission into the management and the operation of the mental health system. We went from having a well-operating mental health system that stakeholders were supportive of and a minister who knew how to manage it to, three years later under Labor and the member for Albert Park, a broken system that required a royal commission to look into why it was broken.

If you were in the corporate world, anyone who broke the system would probably be sacked. But in the Labor Party you get promoted, so the Minister for Mental Health was subsequently promoted to the health portfolio—in the middle of a pandemic, mind you. So you have taken someone who has broken their previous portfolio and you put them in charge of another portfolio which is of critical importance to the people of Victoria at that time, and under his watch we have seen the system collapse. I wonder out loud if ahead of the 2022 election the government is going to declare the health system broken and say that they will do a royal commission if they are re-elected. Maybe after that they will move the minister on to something equally important, something else that he can break.

This issue has not come about as a result of the pandemic. We only have to look at news articles. I mean, the government was given plenty of warning that things were getting worse and worse and worse. Before the pandemic we had in excess of 50 000 people on the elective surgery waiting list, as has been said many times over the course of today. That has gone up to 80 000, and we hear that there are an extra thousand people being added to the waiting list every week. Those opposite seem to think that this is, as the Leader of the Opposition said, a political problem, but it is indeed about people.

I cannot believe the response when we raise issues in question time, which the government have labelled a political stunt but in actual fact are people coming to us—like Rebecca, who we spoke about today and yesterday in question time, who is desperately seeking surgery in relation to her breast cancer. The minister’s response yesterday was to say, ‘Well, tell me about the issue and I will see if I can deal with it’. Rebecca went to the minister twice. She did not come to us first. She went to the person who holds the power to make it right, but the minister did not even give her the time of day, so she came to us and, like with other patients whose issues we have raised, we have been fobbed off by the minister.

I have been here since 2006 and I have seen debates on health issues come and go, directed from various oppositions to various governments. In question time generally at worst there is some faux compassion that is given. I do not even get that from this government. I do not get it from the health minister or the Premier. It is outright contempt for the opposition for raising these issues, because heaven forbid we would raise issues from our constituents with the people who are in charge of managing those issues. Heaven forbid we would do that! Heaven forbid that, in a Westminster democracy, we would come into question time and—I am sorry for saying this—question the government about what they are doing, particularly when the actions of the government are causing untold harm to so many people on waiting lists that are simply growing and growing and growing.

Ms Halfpenny: On a point of order, Acting Speaker, look, I am not sure but it seems to me that the member for Warrandyte has not read this proposed bill that we are debating, and he should be brought back to talking about the actual bill that is in the chamber, a very serious and important bill around protecting the rights of people that are in our health system.

Mr R SMITH: On the point of order, Acting Speaker, the member may not know but second readings form part of the bill. That is how the Parliament sees this, and this is how bills have been looked at many times. Although the second-reading speeches are no longer read in Parliament, they are incorporated into Hansard. The first line is:

Victorians should have confidence in the safety and quality of our health system.

If the minister did not want that issue canvassed, debated and discussed, then the minister would not have put it in his second-reading speech.

The ACTING SPEAKER (Ms Settle): What is your point of order?

Mr R SMITH: I am simply debating the point of order that was already raised, so I am quite within my rights, as the second reading is part of the bill, to debate the issues raised by the minister himself.

The ACTING SPEAKER (Ms Settle): Thank you. There is no point of order, but I do encourage the member to come back to the bill.

Mr R SMITH: Yes, absolutely. The minister at the table, who is the health minister, and the government more broadly have had many opportunities to understand how bad things are getting, notwithstanding I would expect the minister to be getting a briefing. But on 29 July 2020 the Age ran a story with the headline ‘Top bureaucrats warned a year ago’—so that would be July 2019—‘Victoria’s key public health team was starved of money and staff’.

Ms Vallence: That was before the pandemic.

Mr R SMITH: And that was before the pandemic, as the member for Evelyn rightly points out. The article goes on to say:

Victorian Chief Health Officer Brett Sutton’s team was so poorly funded that top bureaucrats warned the Andrews government multiple times the state’s public health unit was the worst resourced in the country.

The article goes on to say that the documents obtained by public health officers in the communicable disease and prevention control unit in Victoria—so these documents have come from people who would probably know; I think we can all agree with that—said:

… a doubling of current staff numbers—

so doubling the staff numbers that the Premier and the minister had agreed on—

would still see Victoria as the least resourced state in terms of staff undertaking public health … duties.

Now, that is nothing to be proud of. Those opposite can point all they want to previous governments and carry on, but this advice was given in 2019, so how can the Victorian public have any confidence in the safety and quality of our health system when the government is ignoring advice?

Another article from 23 November 2020 states:

Victoria has paid the price this year for not having adequate public health resourcing. It’s been inadequate and that’s clear to every Victorian. There was a very regrettable delay when cases started to emerge in June during the second wave and the government’s ability to get on top of that.

This government has let Victoria down, and not just during the pandemic. I heard the member for Melton talk earlier about this bill and how it means that people will get some redress if there is an adverse event. The member for Melton said that people will want to know what went wrong, what was done to fix it and will also demand an apology. Now, I contrast that with the hotel quarantine debacle where 801 people died a result of the biggest public policy mismanagement that this state has ever seen. Those people never found out what went wrong, never found out what was going to be done to fix it and most certainly never got an apology. And why would they? The Premier set up a faux investigation which achieved nothing, and when I last raised this issue the member for Sunbury acknowledged that 800 people died and said, ‘Oh well, I admit that we didn’t get it perfect’. ‘Didn’t get it perfect’—that is the result. That is the narrative from this government: 800 people died, and they did not get it perfect. I mean, that has got to be the understatement of the decade. ‘We didn’t get it perfect’—are you kidding me? So when the government put forward this legislation I think they should have a good hard look at themselves and understand that people do not, as the second-reading speech says, have confidence in the safety and quality of our health system.

The reason why they do not is that successive Labor governments, under the watch of the Premier, formerly the health minister, have underfunded and under-resourced it, and now the chickens are coming home to roost.

Ms HALFPENNY (Thomastown) (18:10): I am rising to speak and make a contribution on the Health Legislation Amendment (Quality and Safety) Bill 2021. While the previous speaker did not really speak about what this bill is actually about and used it as an opportunity to go on with other things, I think it is important that we do go to the content of the bill so that we are actually talking about the instances that are in this bill. I know there were also other criticisms from the opposition. There seems to be a general sort of criticism from the opposition about ‘Why do we need to do anything different?’, because what we are talking about here today is legislative change in order to make the health system one that perhaps better responds to the complaints and concerns of those that are in the health system so that they have an opportunity to hear about the very important treatments that they are getting and if there are any concerns about those treatments that they have the opportunity to raise those concerns and have those concerns addressed by the health profession or the health service they are using.

This is really important. It is not about political pointscoring; it is about seeing where things are not perhaps working as they should be, problems in systems. That is what Labor is all about—making sure that if there are problems, we address those problems. We look at legislative change to address those problems for the betterment of Victorians. We have got to talk about where this actual legislation came from. The amendments form part of the response to the Targeting Zero report, and that came about after the terrible situation of deaths at the Djerriwarrh Health Services. There have been a number of recommendations. Many of them have been already implemented, but this legislation continues to implement recommendations from the report on what went wrong and how we as a government and health services can do things better.

The bill is about facilitating a more person-centred approach through government oversight and better identifying and assessing quality and safety risks, supporting remediation and preventing risks, and improving quality and safety outcomes. Now, of course in saying this and in debating this legislation we also know that health professionals—nurses, hospital staff, everybody—want to do the right thing. There is nobody trying to go out of their way to hurt patients or do things in a way that may cause harm, but through the system and through the resourcing of the hospital and the busyness of hospitals things can sometimes not work out as they should. It is important to have oversight and a system that takes into account those concerns where something may not have worked as it should have and is able to address it to make sure that the person at the centre of the health system does get to understand what happened and get some sort of relief.

So this is all about trying to look at shifting workplace culture towards open disclosure and encouraging inquiry and better protections for patients, and in doing that of course making sure it is not about the blame game. It is not about hounding people out because something went wrong; it is about listening to people, trying to understand what the problem was and what happened and then addressing that in a way that is safe.

In saying that I guess we also should acknowledge that the healthcare workers, whether they are doctors, specialists, nurses, cleaners or all those people that work in the health services as administrators, have done an incredible job over the life of this pandemic. They have worked so hard. I know that they are continuing to have to work many, many hours. I was talking to a resident of Thomastown not about the state health system but aged care, where their wife is required now to work 12-hour shifts. You have to do it, and that is what she is doing. She is actually more than happy to do it, because she feels that she is putting in during these terrible, unprecedented global pandemic circumstances and she is prepared to do what she needs to do to help others. So I really want to send a shout-out to her.

When I look at the electorate of Thomastown, the Northern Hospital is one of the state’s busiest emergency departments. They are treating more than 100 000 patients a year, and we have got—

Mr Foley: The busiest!

Ms HALFPENNY: Sorry, it is the busiest, yes. And I did know that. I do not know why I said that. It is the busiest, treating over 100 000 patients. It has also had to deal with many COVID-positive patients. It is also supporting aged care facilities in the area. And remarkably, on top of all that, they have been able to successfully, through a competitive process, secure a grant from the state government to do a trial on a nasal heparin spray. That is really an incredible trial of an invention where this spray could be used to stop household members contracting COVID. So if there is a person in the family that has COVID, this is a trial to see whether this nasal spray can actually block the virus being transferred or transmitted to other members of the household, which of course would be incredible. It does seem to be working, and it is an incredibly important part of the way of us trying to tackle the transmission of COVID. This is an incredible initiative that the Northern Hospital is very much the main part of, and it is in partnership with Oxford University, Monash University and Melbourne University as well. So we are very proud to see that not only is it working so hard during the pandemic in all aspects of health but the Northern Hospital is also at the forefront of research in order to help us in terms of the pandemic.

I am confident this bill will give patients and their families confidence that where something is not going to plan they will be able to get answers and adjustments. I think at our electorate offices we have all as members of Parliament had people come to us with concerns about health services and hospitals. I have certainly had some around the Northern Hospital. In looking at most of them—I will not say all—many of them are about communication: families have not been told in a way that they understand or it has not been fully explained to them what the process is or what is going on with their loved one. But once the hospital has been able to sit down and do that, then they are much happier and more comfortable about what the situation is. It should not be up to a person to have to ask a member of Parliament to then intervene in that way; there ought to be a system which is much easier, a system that people are aware of, so that they can use that system if they are concerned about something in order to be heard really and to be given the respect to see what it is.

There is also an element that is going to be called the ‘duty of candour’. An expert working group of members was appointed, which included chief executive officers, senior executive leaders, private and public health providers, metropolitan and regional health providers and state and federal health sector regulators, and a peak consumer health advocacy group conducted public consultations to come to this. They consulted with professional associations, peak bodies, the Victorian Clinical Council, public and private health services and consumer representatives to show again how the Labor government is all about making sure that everybody is involved and everybody gets to have a say when we are looking at legislative reform and that we get the views of all those that are part of it to make sure that the system that we are looking at is going to work, for one thing, and is also going to be a fair and just system for all those involved. There was further consultation in March 2021, and the overwhelming majority of these organisations do continue to support the reforms that we are looking at in this legislation.

I think when we go through and talk about legislation like this and the various aspects, it also incorporates Safer Care Victoria, which was introduced some time ago, again as a result of the Targeting Zero report recommendations, giving consumers, if they are not happy about what is going on, a sort of separate entity, if you like, to oversee some sort of investigation into what happened. But I think all of these areas give consumers choice but also support the practitioners.

Dr READ (Brunswick) (18:20): I rise to speak on the Health Legislation Amendment (Quality and Safety) Bill 2021, which is a topical bill given the current focus on our hospital system, indeed our whole health system, as it struggles to handle the weight of the COVID-19 pandemic. But it was a different and tragic set of circumstances almost a decade ago that led to this bill. I am referring to the cluster of perinatal deaths at the Djerriwarrh Health Services in 2013 and 2014 which led to a review that found several of the deaths were avoidable or at least potentially preventable, and a further review found more potentially avoidable deaths at that service between 2001 and 2012. Since that time and in the wake of a broader statewide healthcare safety report called Targeting Zero prepared by Dr Stephen Duckett, there have been many changes to Victoria’s healthcare quality and safety oversight, including the establishment of Safer Care Victoria, the Victorian Clinical Council and—this surprised me a little—the Boards Ministerial Advisory Committee to help the minister cope with the multitude of individual health and hospital boards. I think there are around about 88, which is a unique characteristic of Victoria’s health system.

Late last year we also debated the Health Legislation Amendment (Information Sharing) Bill 2021, which is currently resting in the other place, which I spoke in support of last year and which will hopefully allow critical patient information to be more easily shared between Victoria’s separate hospitals and other public health systems. Improving communication is vital to improving patient safety. The number of errors that I have seen and that any of us can imagine that result from different bits of important medical information sitting in different hospitals or different health units, or rather the percentage of those errors, is very high. I would go so far as to say that most serious health errors are due to a breakdown in communication, so by treating our divided health system more as a unified system and allowing information to move freely between hospitals we should be able to prevent a good many of those errors.

This bill implements the final legislative reforms recommended by the Targeting Zero report, and one of the most significant of those is, as we have just heard, in fact Australia’s first statutory duty of candour for health services. The duty of candour means simply that if a patient suffers due to a serious preventable error or accident the health service owes a duty to the patient to acknowledge fault and to apologise and provide an explanation of what happened and why. The proposed duty of candour will apply to severe incidents. This frankness and honesty, or candour, should already be the standard for communication between health professionals, health organisations and their patients. That it sometimes does not occur is often because practitioners or health services are nervous about apologies constituting an admission of guilt in civil court proceedings despite this not really being the case in any legal sense. New section 128ZD inserted by this bill reaffirms legal protection where it expressly provides that an apology is not an admission of liability.

I support these new provisions, but I should make the point that simply legislating a duty of candour does not guarantee good clinical communication or good clinical practice. Those who now have this obligation of candour must also embrace the spirit as well as the letter of the law, and I think this is particularly important in terms of timeliness. I can see how this duty of candour, which will lie with health services more than with individual practitioners, could be something that a service could ultimately fulfil but only after considerable delay and much thought, when a prompt admission of responsibility is much more likely to be reassuring to people who have been affected. So it needs to be more than a box-ticking exercise. It needs to involve genuine care, compassion and sensitivity, and so the health department has a responsibility, I believe, to make sure that that is what happens.

The bill also contains other measures aimed at improving the quality and safety of health care, including creating the position of chief quality and safety officer to conduct quality and safety reviews. But when discussing the quality of patient care in Victoria, particularly in the current context, the important issues raised by the Targeting Zero report go beyond things that can simply be legislated. Targeting Zero reported:

… complications are rarely the result of individual incompetence or malice. Rather, they arise within complex, high-pressure environments where mistakes easily occur and patients are often already frail and at risk of deteriorating.

We should note that this description—a high-pressure and complex environment—was made prior to the current pandemic or ongoing code brown pressures. The fact is that when a health system is only funded so that it is always at or close to 100 per cent capacity, doctors and health staff will not be able to admit all patients to hospital that need to be admitted because there are not enough beds and nurses and junior medical staff are often exhausted from working multiple shifts to cover staff shortages or working overtime. This is where most mistakes are made and where quality of care suffers.

I can just quote one easy example where, as a junior medical officer many years ago in a hospital a long way away, I sought advice from a more senior staff member, a more senior physician who was clearly—clear even to me—too busy to give enough of her time to the problem I was presenting. She reassured me it was fine to send the patient home, and it was not. The important point here is that when staff are too busy other staff need to recognise that and there needs to be capacity in the system for advice to come from somewhere else, for someone to be available on the phone or for someone to be available to be called in in a way that still is not happening sufficiently.

I think the current circumstances are completely understandable, but we should not always be under that sort of pressure—and it was happening too often when a flu season was a bit bigger than normal. It is the result, really, of a health system that always aims for ruthless efficiency and delivering the highest quantitative output for the lowest possible cost. No system is infallible, but an under-resourced system will always be more vulnerable. This also applies to governance arrangements, and I will quote again from the same report, pointing out that:

The department has suffered a significant loss of capacity in recent years, in some cases creating or exacerbating these problems. Many dedicated departmental staff have called for change but lacked the authority or resources to achieve it. Budget cuts and staffing caps have gutted many departmental functions. The department has become increasingly reliant on external consultancies when the work would have been done better, and more cost-effectively—

meaning within the department. This was the state of the health department with which we confronted this once-in-100-year pandemic. Of course no public health system can be fully equipped and staffed to manage a disease like COVID-19 spreading through an unvaccinated population, but it is also clear that Victoria’s health system struggled to function effectively in part because it was already so lean.

Victorian governments for the past 30 years have made policy and funding decisions based often more around election cycles than actual community need. Often the more glamorous parts of the health system have got more funding, particularly around election times, than the less glamorous bits. The inevitable result is that bureaucracies and departments have been gutted and have been less able to function in times of pressure. Then only after experiencing preventable tragedies and loss with much regret do governments rebuild bureaucracies that had been decimated only a few years before, at far greater economic and human cost than would have otherwise been the case.

What happened at Djerriwarrh was tragic and avoidable, but it has led to some positive change. There have been some positive changes already to the health system as a result of the COVID-19 pandemic, but we should not waste this crisis to drive further improvements. We cannot always continue to chase our tails. With regard to building this Victorian health system, we should seek to enshrine some common qualities and characteristics that future governments should commit to over the longer term. Obviously proactive good governance means maintaining a well-resourced health department, evidence-led reform does mean listening to health experts and funding and staffing must be maintained comfortably above the absolute minimum level possible.

I am still struggling, though, to figure out how you build capacity into a health system that you might only plan to use for an occasional epidemic or pandemic. There is not really a health equivalent of, say, the army reserve, and it is hard to imagine how such a system might work. One area, though, within the health system might lend itself to be expanded when we are not under pressure and be drawn upon when we are, and that might be community health. It could be that community health is one area where some additional funding would enable it to provide services that could be suspended for a period of months during a severe epidemic or even a bad flu season. I raise that as an idea only, but there may well be many other ways in which we could do this.

Victorians once had great pride and confidence in their health system. It is perhaps the only thing that many of us do not mind paying taxes for, if we know that it will always be there for us when we need it. But we will not get the best healthcare system in the world by just saying it over and over. If that is the standard we aspire to, then successive governments over decades must continue to give it priority.

Ms CONNOLLY (Tarneit) (18:32): I too join my colleagues to make a contribution on this bill. My colleagues have really gone to the heart of what this bill is about and how the Targeting Zero report was so very important to, I would say, every single Victorian. I want to talk about the importance of this bill in terms of something that happened to me that means I can relate to the importance of having open, transparent disclosure about a tragedy, something that happened to my husband and I and our family.

But I do want to start by acknowledging the families that have suffered such tragic loss as part of that cluster of perinatal deaths at Djerriwarrh Health Services. No family should ever have to go through what those families went through, and we hope that it will never happen again. That is why we are here today. That is what this bill is about, that is what the inquiry was about, what the report was about, and hopefully we will now have this legislation in place to make Victoria a better and safer place.

The expert working group appointed to advise on Targeting Zero consulted extensively on the introduction of the Australian-first statutory duty of candour in Victoria. This consultation was really important because it revealed what is a really significant appetite in the health sector for greater transparency and a really strong belief that members of the Victorian public are entitled to it, and that really struck me as to why this bill at this time is so very important. As human beings, when something happens to us, whether it is tragedy, pain, loss—there are many different ways you can describe it—the first thing we want to know is how: how did this happen and why did this happen? Sometimes I think that is just part of human nature. I know that because I deal with the how and the why almost on a daily basis.

I am going to talk about something this afternoon very personal to me. I am not sure how I will go getting through it. I have ummed and ahed about whether to raise it here in this house. I have talked on many occasions here about the death of my first child, my daughter Viviene, who would be 13 now. One of the things when we lost her that people wanted to know was, ‘How did that happen? Why did that happen? How could a baby who was fine one moment suddenly not be fine the next?’. To this day we do not know what happened to Viviene; we will never know. It has been 13 years, and I think now as I get a bit older and wiser that maybe it was fate, because I do believe in fate. We will never know. Maybe we were never meant to know.

But there was something that happened in the moments, the days following her death, something really important, so important in fact that when you lose a child and you have a stillbirth like we did counsellors come in, lots of counsellors. You lie there on the hospital bed. Maybe you have your baby in the room with you, maybe you do not. But counsellors come in and they want to talk to you about something that is really important. Why can babies die in utero? We do not know enough about that. There is not enough research, and one of the ways to get that research is through an autopsy. So we had counsellors come in and they talked to Scott and me all about what an autopsy is. What is an autopsy? What happens to your baby? What would they look like after an autopsy? Would you want to see them? They were conversations that we had I think probably the next day after I had given birth to her. I look back to then. I probably did not sign that consent form to better the research and save other babies. I wanted to know what happened to my baby and whether that could ever happen again to my future children. Was it something genetic? Was it a heart defect? So we signed that autopsy consent form. Ironically one of the reasons why we did not see Viviene before we buried her about 10 days later was because I was not quite sure whether I could handle what she looked like after having the autopsy, and that is a really important point.

So months went by and Scott and I wanted to have another baby. We were desperate to have another baby. We had to go through IVF, but we were waiting. We were waiting to get the autopsy report to tell us why our baby had died and whether it could happen again. At about the six-month mark we got a phone call from our obstetrician, who was really distraught because she had just taken a call that an autopsy did not happen. We had buried Viviene, and no-one had picked up her body from the hospital morgue to conduct that autopsy. The funeral director thought that we had changed our minds, because parents change their minds about autopsies on babies all the time.

I do not have enough time to tell you about the hurt and the trauma and the grief that added to our pain and our loss. But it also instilled a huge amount of fear in Scott and me. We wanted another baby. We were not sure if that baby would meet the same fate as our Viviene. As it happened the pregnancy with Emily was very traumatic and I was hospitalised many times, and my other two children subsequently were born at 37 weeks, which is kind of premature—the lungs are not really ready and have their own complications—all because of that autopsy report that was never undertaken.

This is really important because I was in Queensland at the time. Like I said, it was a long time ago. It struck me that this is an important bill, but it has taken a long time to get here, too much pain and too much loss to get here now. What we went through—I only know it as open disclosure. I was really angry and I wanted answers. How do you sign a consent form for an autopsy for a baby and their body is not picked up by pathology to do one? I wanted answers. I wanted to know who owned the processes, who would sign the body in and out and all this kind of thing. I sat down in front of a full panel of very, very, very senior people at the hospital. I think it was one of the first times that this had been undertaken. We had the head of midwifery and the head of nursing, because this was quite a serious thing that had happened to us. It was really difficult to hear what had happened, because at the end of the day it turns out that when you have a really terrible thing like a stillbirth, it does not happen often but it happens enough to have a flowchart to let midwives and obstetricians know what to do and how to help the parents. The person who needed to call, I think, pathology to order the autopsy—that was not part of the flowchart. And because it was not part of the flowchart, no-one knew they had to make that call and that was their job. And that is what happened—something really simple. It was almost nobody’s fault. It was like I talked about earlier about fate. Through that open disclosure we were able to talk about our pain and our hurt that we had felt because they had left it off a flowchart.

I do hope that the parents and families who have suffered loss as part of Djerriwarrh Health Services, that cluster of families, know that something is being done. It will not bring their babies back. Having that meeting with that hospital did not bring Viviene back. It did not make me feel any better at all. It did not give me closure. But it helped me in a little way to take a step forward, because what I knew was that when I walked out of that room it would be on the flowchart and that would not happen again and someone would have an answer about what happened to their baby and why they died.

Now, I share this story because probably people can share similar stories about having incurred hurt and loss and harm. To us it just happened. It was left off a flowchart, and we do not have any answers. But this bill is something that will change that. It will help improve practices because hospitals and health service staff will have to have the conversation. Sometimes it is a brutal and emotional and haunting conversation. It also gives patients like me—the people that have to live with the loss—an opportunity to talk about their hurt and their pain and have someone listen to it. This is a really important bill. We have heard a lot about health today, but I am glad to have been able to share the story of what patients will be feeling.

Mr RIORDAN (Polwarth) (18:42): The issue of quality around health care and its impact on families and those who have experienced adverse effects has been well highlighted by the member for Tarneit, and there are many examples I am sure for many families where the cathartic nature of having openness and honesty and transparency in health is a really important factor. My family too has been touched in many ways by that.

But to the bill at hand: I refer very much to the Minister for Health’s second-reading speech, where he said:

Victorians should have confidence in the safety and quality of our health system.

That is something that is severely lacking in Victoria today. We heard in question time today example after example after example of where the quality of health care in Victoria is being badly compromised. This is a healthcare system that, unlike any other healthcare system in Australia, has had the Premier not only as the Premier but as the health minister for the best part of 20 years. One person has been responsible for the outcomes we see in this state. No matter the excuses given regarding the once-in-100-year pandemic, which is now the catchcry for every problem in health, let the record show that these are not new problems. These are problems that have been around a long time. I can speak to this because I was on a health board for 16 years—a country health board, an underfunded country health service surrounded by 10 others in my electorate—and I know only too well how much our health system relies on the goodwill of people to provide essential services.

Some of the heartbreaking stories that we heard in question time are only the tip of the iceberg. Young children are being denied health services—important surgery for cleft palates. We have heard endlessly about people with delayed cancer treatments. We have heard endlessly about how if you needed hip or knee surgery back two years ago, you are probably still waiting and enduring the pain and discomfort. The question quite simply is: Minister, will your truth telling in health actually deal with these people, and will you let them know what the reason is for years taken from their lives, years added in pain and discomfort? Will this truth commissioner, this truth teller in health, actually reveal to Victorians why they have had to endure that?

One of the starkest, most troubling examples of how under pressure and out of whack our health service is is in my electorate, where the local ambulance services have nearly doubled their workload—and it is good that the minister is here today and hopefully he is listing. The workload has been doubled not by COVID—not one extra COVID patient has added strain—but because people have been living in fear for two years. They have not been getting their medical treatment. They have not been travelling from their isolated country home into the nearest town to see their GP and pay for that service. They have been sitting at home in fear too scared to come out and worried that their presence and seeing to their own health care will in fact put a strain on your health system, Minister. Night after night you can tell that people cannot cope with the stresses of COVID. These good country people believe they are doing the right thing, but the reality is they are harming themselves and they are reducing their life expectancy, and it is simply not good enough.

For example, on the statistics of that, there has actually been more than double the number of ambulance call-outs the operators tell me for the hardworking ambulance officers. Keep in mind that four of the ambulance services in my electorate are actually provided by volunteer ambulance crews—to think in this day and age that we have still got those people out there providing essential ambulatory care to go to heart attacks, go to strokes, go to fatal car accidents and tragedies and, in a tragic case recently, a very sad workplace accident in our area. Minister, these people’s workloads have doubled because these are 100 per cent avoidable medical interventions. They are for people who should have and could have gone into our health services and gone to their doctors to prevent it.

When we see a bill that comes in here that speaks to the value of telling the truth—giving people honest answers about what is happening in their health service—it is unsettling for me. On one hand the government is wanting the practitioners and the people working at the coalface in health to be honest about what has gone on, and there is no doubt that that is a good thing. For most people if they just know what has happened or how it can be prevented or that it will not happen to someone else, it sets their mind at ease. But, Minister, we have the government setting this standard and then not applying it to its own operations, not coming out and being truthful with people. Where are the 4000 ICU beds? Where are the container loads of ventilators that were promised?

A member: Hotel quarantine.

Mr RIORDAN: Where are the hotel quarantine beds that are going to keep people safe from each other? All these things, night after night—

The ACTING SPEAKER (Ms Settle): Member for Polwarth, through the Chair, please—not directly to the minister.

Mr RIORDAN: I was just hoping the minister heard it.

The ACTING SPEAKER (Ms Settle): The ruling is through the Chair, please.

Mr RIORDAN: No, I accept that—thank you, Acting Speaker. Night after night we have heard these promises from the government, and like the intent of this legislation, the Victorian community will benefit greatly from the truth being told about where our health system is. The biggest truth the Victorian community want to hear, and they want to hear it very, very immediately—they want to hear it today, actually—is when we are going to get back on track with health care. When will we get back to biting into that massive waiting list? The government says it is 80 000 people. The minister was unable to tell us how many people are waiting in the private system, but if it is 80 000 in the public system, we can guess the number is going to be somewhere near that or close to that in the private system as well. There is a massive backlog. Of course we know that that waiting list is so manicured. It is like an English bowling green: it is kept very, very tight and well cured, but the reality is there is so much more around it. There are so many people that have not even got on to the waiting lists yet.

And so Victorians want to know when that is going to be seen to, because we know the long-term health benefits to people in pain, to people who have had to give up jobs waiting to get their hips or their elbows or their backs or whatever fixed. The consequences of poor health lead to so many other negative outcomes for people in their homes, in their lives and in their families. As Victorians we know that truth telling has its benefits. We support the concept of truth telling in our private health care, but we want the government to do it as well.

The other issue that is of great concern to me, particularly in our rural health services, and the concern I would have about this particular piece of legislation where it starts legislating more obligations for health services, is so many of our country health services are very burdened by the bureaucracy and the demands of the Department of Health in order to fulfil its bigger claims. All our health services, and there are 10 in my electorate, are really required to carry out the same bureaucratic and process systems as the largest metropolitan health services in Melbourne with many, many more times the staff and budgets at quadruple and many, many hundreds of millions more than a small country health service.

It would be my hope that the government will see good sense and make sure that any attempt to add greater transparency to the health services will come with the required funding to support those health services, because I know from going around my electorate talking to the various health services that I have that many of those organisations are under enormous pressure to provide this type of service. Going forward, if we are to have the necessary truth telling, if we are to work with patients and medical workers and people in the health system, they need to know that the resources will be there to support both the workplace and the clients that come in, because often they require a lot of attention. They will require time spent with them to go through it, and our smaller rural health services will definitely need support in order to keep their end of the deal in making sure legislation such as this sees the light of day.

Ms HALL (Footscray) (18:52): I would like to begin by acknowledging the contribution of my friend the member for Tarneit and thanking her for sharing her very personal story and experience with the health system and the importance of those little decisions every step of the way and the impact that they can have on your life. Of course I also want to acknowledge the many families in Melbourne’s western suburbs and beyond who would carry the very heavy burden of loss from those tragic losses at Djerriwarrh.

I remember that time very clearly because I was going through IVF myself. It was when I first met the member for Tarneit, and I remember telling her the story of my complex pregnancy. She was kind enough to share with me her encouragement to always check if you felt like something was going wrong. There was something wrong with my pregnancy, and I will be forever grateful that the care I received at Sunshine Hospital was perfect. I had great care. When I first became pregnant we were told that we had a baby with trisomy, trisomy 18, which is Edwards syndrome. Babies with Edwards syndrome do not normally survive longer than a week after birth. Almost miraculously, after a very difficult few months we were told by the geneticist that in fact the placenta had the trisomy and we had a condition called confined placental mosaicism, which is where the trisomy is located just in the placenta but the baby is fine. But what that meant for my pregnancy was that I had to be monitored very closely throughout it, because there was a risk that the placenta would fail. Throughout that time I felt so well supported by the health system, even though I was second-guessing every day, every time I could not feel the baby move. Many of you would be familiar with Matilda, who charges around the Parliament from time to time and is often given ice creams by the member for Yan Yean and was told by the member for Preston where the chocolates are hidden in the library—as it should be. I was so saddened to hear that story from the member for Tarneit, because I have heard a lot about Viviene over the years, and I know how hard it is for the member.

We need of course to have the highest standards in our hospital system, and as the member for Melton said, our brilliant clinicians do not intentionally make mistakes. They are all there for the right reasons, but having these processes in place safeguards everyone. It is about openness and transparency and for patients to have the answers that they deserve in our world-class health system. I feel very fortunate as well that the Minister for Health is in the chamber, and I would like to acknowledge his work in our health system. I think about it daily when I pass the site of the new Footscray Hospital, which has many cranes coming out of the ground. Not only will they have those right processes in place for patient care and best practice, but the staff will also have the best facilities in the world to work in, and that is a marvellous thing for the people of Footscray and Melbourne’s western suburbs. At $1.5 billion it is the largest capital investment in a hospital in Victorian history and something that we are enormously proud of.

I would also like to reflect on the contribution of the member for Altona, an amazing reformer in this government. Her work to ensure that we have a health system in Victoria that is accountable to the highest clinical quality standards has been remarkable. It is crucial that we have a robust framework that has the confidence of patients and clinicians. When I think about her reforms in Victoria in a broader context, I think that most of us would be happy to leave this place having made a fraction of that extraordinary contribution she has made. Victoria is a leader in patient-centred health care in many regards because of the member for Altona.

In health care the highest standards of clinical practice are supported by great infrastructure, and we are going to have that in Melton. We have it in Sunshine in the new, beautiful hospital for women and children, the Joan Kirner Women’s and Children’s Hospital, and of course emerging out of the ground in Footscray. I think having best practice care from the clinicians and processes that patients feel supported by and can trust is a remarkable thing.

We are very lucky in Victoria to have such an outstanding health system. But I do reflect and I did reflect when I was writing this contribution on that very heavy grief that those families must feel. I hope that these reforms in some way bring them some comfort that those mistakes will not happen again. It was a very distressing time, I think, in our health system in Victoria to learn of those mistakes, those gaps and failings.

The DEPUTY SPEAKER: Order! I need to interrupt the member. I am required under sessional orders to interrupt business now. The member may continue her speech when the matter is next before the house.

Business interrupted under sessional orders.