Wednesday, 12 August 2026

 Emma KEALY (Lowan) (18:01): I continue on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2026. This is a very important piece of legislation because the aspiration, what the government is setting out to achieve, is a good thing and is important. We need to ensure that people who enter Victoria’s public health system receive the support and care that they need and deserve. In health care there is a very important driver to better patient outcomes, and that is the right care at the right place at the right time. This is never more emphasised than when you live in rural and regional Victoria, where access to health services is much more difficult. My colleague and electoral neighbour the member for South-West Coast can attest to this. The challenges that we face in south-west Victoria and western Victoria are a different perspective than what residents of Melbourne have to face when it comes to attending a health service and getting an appropriate level of care. This is not a reflection on the healthcare workers themselves. What unfortunately happens as a result is when you look at the health outcomes in our electorates in rural and regional Victoria, we are on top of the worst indicators. We have a shorter lifespan, we have a higher rate of mortality five years after diagnosis of cancer and we have higher rates of heart disease and of lung disease. Skin cancer is another – we have higher rates of that. Something that I am certainly noticing – and this is just an observation rather than being evidence based – is that the number of men diagnosed with prostate cancer in my electorate is exceptionally high.

I will take prostate cancer as an example. The challenge for men who are diagnosed with prostate cancer in my electorate of Lowan, particularly around the Wimmera region, at this point in time is that Richard McMullin has retired. He was the urologist who serviced from Ballarat right through to the border. He is a very good human. I know Richard well. He was the urologist in charge of my father’s prostate cancer. He retired a little while ago, and I would like to acknowledge and thank him for his service to health care. He certainly had a huge impact on so many men and women facing urological issues. I do appreciate the contribution that he made to supporting health care in rural Victoria, because not every specialist is willing to do that, and some do not do it as well as Richard did. So thank you, Richard. But upon his retirement that position has not been filled, and I have had a number of local men come to me in situations where they simply cannot find a urologist within the Grampians Health network that will take on their care.

We have some members of our local community who, rather than travelling to Horsham for care or travelling to Ballarat for care, are actually having to go to Melbourne for care. In this scenario this is of course a long distance. My electorate is a long way away. Horsham itself is about a 4-hour drive. I had a case of somebody who was in Rainbow who had to drive to a urologist in Melbourne – that is getting to over a 5-hour drive. It is not just the cost to do that – there is the Victorian patient travel assistance scheme, which provides a small contribution to cover fuel costs to get to an appointment in Melbourne. Our patients have to travel on pothole-riddled roads, and as we know in rural and regional Victoria our roads are falling apart. I have a resident at Lake Bolac who had to travel to cancer care in Ballarat. In that journey she did seven tyres and fractured five rims. This is the additional cost of accessing care when you live in rural and regional Victoria.

There are not connections that are there when it comes to the public transport system. We still do not have access to a public train system in all of the Lowan electorate. It is 20 per cent of the state, but there is no train service. It is outrageous, and it should be instated. There is the demand for it; there is the need to do it. When you see that we have got free travel in Melbourne on trains and trams, on public transport, our people miss out because they do not have access to those services. It is the inequality that we see under a Labor government. There is so much focus on things that happen in Melbourne, but some of the people who have the worst health outcomes are missing out. They are paying more and getting less under a city-centric Labor government. It is very frustrating for people who live in regional Victoria to feel like they do not count and they do not matter under Labor. We need to ensure that we have access to this care, so while I understand this bill is about nurse-to-patient ratios, there are so many levels to better access to care and better quality of care that are beyond nurse-to-patient ratios.

I was very proud to stand with the Leader of the Liberal Party Jess Wilson and the Leader of the National Party Danny O’Brien at Hamilton Base Hospital recently. I had the member for Gippsland East and the Leader of the National Party, and we were able to announce that the Liberals and Nationals in government would contribute $45 million to finally upgrade the emergency department and intensive care unit at Hamilton hospital. This was so warmly welcomed by the hardworking staff in the emergency department and the wider Hamilton community and across the entirety of the Western District, because that emergency department is falling apart. It is outrageous that our healthcare workers have had to put up with those conditions for such a long period of time. I am so proud to have committed to that at the last election, that $70 million. We have now upped it. We are doing more. We are going to invest $45 million, and I cannot wait to see that happen, because I know that that is the way the Nationals will deliver better health care for local people in regional Victoria. It is time for a fresh start. We need to make sure we get our fair share to regional Victoria, and investing in Hamilton hospital is exactly how the Nationals are going to achieve that.

We know that the commitments within this legislation around nurse-to-patient ratios are important, but there are concerns that have been flagged by the sector in relation to how this will look in practice. While it sounds important – and it absolutely is important – we need to ensure that there is not just a ratio, we need to ensure that we have got positions filled, we need to ensure that we have got enough workforce trained and ready to fill those positions, and we need to make sure we have a workforce that can fill positions in areas where it is traditionally more difficult to attract and retain staff, which are in rural areas of Victoria. This is often the big challenge when it comes to Labor. It is all very well and good to put in an enterprise bargaining agreement or in legislation a requirement for a greater level of staffing within our health services, but you can only deliver that with the same level of services if the government also provides the funding to that health service so they can pay these staff and so they can pay the nurses at the right level commensurate with their experience and their skills and qualifications. This is what we do not get through this legislation.

There were questions put through the bill briefing, which we have not received a response to yet, about what additional funding will be provided to the public hospitals to ensure that they can deliver on this legislated requirement to increase nurse-to-patient ratios. This is the key question, because we need to make sure the funding is there, otherwise hospital boards and CEOs will be in the incredibly difficult position of working out how they can fund a legislated requirement to increase the ratio of nurses to the number of patients that they have. The only way they can achieve that is by shutting and reducing services. Basically you cannot do anything else within the healthcare system. They have been cut to the bone. There are what are called efficiency savings. Every first of July, the new financial year, the hospitals get their new budget to understand what they are going to have to fund their health services over the coming 12 months. But if there is an efficiency saving – which there always is – it means that CEOs and boards have to make the decisions: how do we fund the EBA increases that are coming through? How do we ensure that we continue to actually serve our community by delivering the health services that people in our community need? And how do we make ends meet? It is about hospitals doing more with less, but it comes to a point where there is only one decision to make, and they have to shut services. This is an exceptionally difficult decision to make, but it is one that is put in place because they have a legislated requirement or an EBA which they have to meet and they are not given the funding by the Labor government to be able to deliver on that. It is a very simple economic proposition which just does not stack up.

It is a challenge for every health service how they deliver on that, because they take their role in the community very, very seriously. They understand that health care and hospitals particularly are some of the key employers in our rural and regional towns and cities. They know that the people who are in those senior positions in health in hospitals are often also taking on leadership positions within the local community. They are taking on positions within the local football or netball club, they are on school council, they are leading in volunteer roles. Many are naturally leaders and decision-makers, and so they give back to their community in so many different ways, so if we do not support particularly our rural health services to have that stream of people in senior positions, in leadership roles, who have got additional skills they can bring not just to their employment but also to the community, we are going to have a decline in our rural communities. There is also the flow-on effect of what it means for our rural communities if there are not senior decision-making positions in health services in the smallest communities in our state. If we do not have that economic driver of senior positions in health care in regional Victoria and rural Victoria, we take away so much of the support and donations financially from supporting our small businesses in regional Victoria – the donations to our clubs and schools and all of those things that make our regional communities so vibrant. It is not just the volunteering; it is the financial donations as well. This is what makes people who live and work in rural and regional Victoria so special: they give so much more than just turning up, and we should be supporting them and our rural and regional communities at every single opportunity.

In regard to some of the detail around this bill, as I said, there are a number of changes to the schedules or the hospital levels, where a number of hospitals are upgraded or reclassified – that is outlined in the legislation. But I would like to point out some changes relevant to my electorate of Lowan, whereby Grampians Health Ballarat Base Hospital has been classified as a level 1 hospital; Grampians Health Wimmera Base Hospital, the Horsham campus and Natimuk and Dimboola as well are level 2 hospitals; and the Willaura campus of the Ararat hospital, which is just out of my electorate and which East Grampians Health Service certainly has responsibility for, has also been reclassified. It is a fabulous health service in the beautiful community of Willaura and has one of the most outstanding and generous hospital auxiliaries I think in all of the state. They do an incredible job there with fundraising activities in particular, but also they volunteer an enormous amount of time to support their residents and patients at Willaura hospital. Ararat hospital has been classified as level 3. I would also like to note that there has been a reorganisation of category 3 emergency departments. That category ‍3 has been replaced to include Hamilton Base Hospital, that fabulous hospital that I worked at about 20-odd years ago. It seems like a long time ago. When you look back and you see some of the people at Hamilton hospital – and we can share memories about how fabulous the muffins were on Thursday in the tuckshop that we would go in and look out for – we know that there are some good memories there. It is probably reflective of the culture within our health services: it is a community. People go through the stresses, some of the trauma that they see and the experiences, and they form extraordinarily close relationships that last a lifetime.

I would like to now just go through some of the concerns in my final elements of this contribution. Just as in the previous ratio-amending legislation, it is unclear if the allocated funding will be sufficient to meet the higher cost of employing more casual agency nurses if hospitals are unable to recruit permanent staff. This is the hidden cost of a rapid transition to an increased level of staffing. It is not talking down the increased level of staffing, it is just saying that if we do not have enough workforce to permanently fill these roles, there is an additional cost if agency nurses or locums are used to fill those vacancies – and there is a massive cost around that. It does also have a flow-on effect not just financially but within the culture of a ward. If you shift from stable employees, where people are embedded in the community and they have been working together for a long time – those wards tend to work in a more positive way and are, I think, probably culturally a more positive environment – once it gets to a tipping point, where there are a large number of agency nurses coming through, where they might only work one weekend and then they do not come back again and you have this constant churn and shift, there is a fracturing of what happens within the relationships within that health service. So there is a two-fold cost, as I will refer to it, in terms of these rapid shifts to an increased level of staffing.

Given the significant financial pressures throughout Victoria’s health system, the new nursing ratios could lead to further budget constraints elsewhere, such as in planned surgery and emergency department capacity. This is of great concern to Victorians, because we know these are already areas where there are bottlenecks in the state of Victoria. We know that waitlists for planned surgery have blown out for a long time now, and the Labor government are not getting on top of those, which has a consequential impact on people being unwell and presenting to emergency departments. Then on the other aspect, we are seeing hospital ramping and patients having extraordinarily long stays in emergency departments not just for physiological reasons but also presenting with mental illness, and that is very, very problematic. An emergency department is not where anybody who is facing a mental crisis should be waiting for not just over eight hours but sometimes for 24, 36, 48 hours and up to 72 ‍hours. It is not a safe environment for them and can cause an incredible amount of trauma; it is just not appropriate care for that to happen. But we are seeing these wait times in emergency departments continue to extend out more than what the government’s own target times are for these KPIs.

As I referenced earlier, department staff were asked in the bill briefing if all hospitals are meeting the current ratios, which commenced in full on 1 July 2026. This question was taken on notice, and at the time of the writing of this bill report, it had not been responded to, so it would be fabulous if we could get that information to the Shadow Minister for Health before this bill is debated in the other place.

Both the second-reading speech and the Australian Nursing and Midwifery Federation’s feedback refer to the new ratios as providing opportunities for graduate nurses. This comes at the same time that hundreds of graduate nurses missed out on a place in the public system this year, with an expected increase in the number graduating in 2026. There may even be more graduates unable to secure a position. This is something that is quite perplexing to me, that we are actually undertaking an enhanced level of training and we are getting these graduate nurses coming through, but there is not a job available at the end of that training. This is something that is very frustrating and has an impact on graduate nurses as well – they feel like they are not valued. They put all this work in, they were told that there would be a job at the end of it, and then they go to apply and there is nothing there.

We have seen a very similar pathway with paramedics, where a program was established to train up paramedics, and then they go and apply for a position. There are so many that were unable to secure a position, even though we have got so many problems within Ambulance Victoria and we are seeing positions going unfilled for extended periods of time. In my electorate of Lowan, in the northern area, in the Wimmera area, we have not had a MICA paramedic from Ballarat to the border for the last month or longer. In fact there are four positions that have gone unfilled permanently for a number of years now. They have never been advertised. There is no attempt to fill these positions. Of course when positions are not filled, they do not need any money. There are all the budget announcements: ‘You’re going to get funding. We’re going to fund these positions.’ But then they are never filled, so the money never goes out the door and access to care deteriorates and gets worse. That is what I am very much focused on.

Let us look at the outcomes. What are the outcomes to make sure we are supporting a healthy workforce and a workforce that feels valued and important and that they are recognised for the skills, experience and qualifications that they have, versus people who feel like, ‘I’m the only person left out of a team of four. How do I work in this environment when I’m continually being asked to do more overtime, to work additional weekends, when I am spending more and more time away from my family, when so much more is being asked of me because I haven’t got the people around me to fill these positions?’ This needs to be addressed. It is a critical problem because there are people who are not able to access MICA services in my area, because we do not have anyone filling the roles. This is putting so much pressure on our local paramedics. It is not fair to do that, and it must be addressed.

The Australian College of Nursing also raised concerns around this legislation that additional funding may be needed to meet the higher cost of employing more casual agency nurses. Legislative ratios combined with workforce shortages increase reliance on agency nurses, which can impact hospital budgets and also affect continuity of care. The Australian College of Critical Care Nurses also provided feedback. They too support the bill’s intent to strengthen intensive care services but raised concerns about whether there is a sufficiently skilled critical care nursing workforce to meet the new staffing requirements – so a commitment that we will have these positions available. But how do we fill them? Because we have not got enough critical care nurses trained up to deliver those services, and they have not got enough experience to deliver those services. Let us be clear: critical care nurses are amazing. They have so many skills that are vital, particularly in rural and regional hospitals, where the more skills you can have on deck, the more flexibility you have in the type of care you can provide and the types of patients that you can treat. It takes so much pressure off the entirety of the healthcare system. We absolutely need to see more critical care nurses trained up and embedded into the workforce, but there needs to be a commitment. How do you train that workforce to be available to fill these roles? The ACCCN highlights the importance of workforce capability for safe ICU care, not just numbers of nursing staff. They warn that expanding staffing numbers without expanding the pool of suitably trained critical care nurses could lead to shortages of experienced staff and difficulty filling senior ICU positions, and that would be an unintended consequence. We do not want to put more pressure on our senior, most experienced clinicians because they are not well supported enough.

There is one other matter that I would like to raise, in relation to some of the challenges that we have seen over the past probably eight years where it has been rolled out – that is, the merging of multiple health services into one single health service. I would like to particularly point out the merger of a number of hospitals in the Wimmera to form Grampians Health. Before this was announced there were certainly grave concerns flagged by community members. I even recall Bill Ower, who was walking up and down the main street of Horsham with a sandwich board on. If you look at what was on that sandwich board, he highlighted then exactly what is happening now. In Horsham we have had a terrible hit to culture among our fabulous healthcare staff. I would like to acknowledge them, because I know they are doing their best in a really difficult environment, but they feel like decision-making has been taken away from them and centralised to Ballarat. Senior roles have been removed and shifted to Ballarat, which let us face it, is 2½ hours away from Horsham. When there is a shortage of specialists ‍– Dr McMullin retired, and we have got a shortage of urologists – they are not sent to Horsham. Instead the patients are sent to Melbourne. There is a diminished availability of access to services. There have been extended periods where dental services have not been available. The social worker very early on was removed from Edenhope hospital. The dental services have been completely closed at Edenhope hospital. We see so many services that were being provided under the older model, which may have been more for the department to manage because there were more CEOs to manage, and not all CEOs are straightforward and easy to work with. Some challenge the department and want to do things differently and fight for their local people and deliver the services that their community needs. But there are local people that are missing out on access to health services, and this has not changed since this merger took place.

This merger is far too big. Ballarat should not be within the Grampians Health network – it should not take control of the hospital – which goes right through to the border of South Australia. It is not fair for anybody with an exceptionally high prostate-specific antigen to see a GP in Edenhope and be told, ‘I’m sorry, there is no urologist we can refer you to within the Grampians Health network. If you are having trouble sleeping, take some magnesium.’ That is disgraceful health care. That is not what should be delivered and it is not caring at all. We need to make sure our public health system is there for everybody in our community in Victoria, no matter where we live. I would urge the government – I know there are only perhaps a few months left – to reconsider and review Grampians Health. As I said, the staff are amazing. They are doing absolutely the best they possibly can. But Ballarat hospital, a major hospital with its own funding issues, its own bed block issues, its own emergency department issues and its own culture issues, should be standalone and do what it is good at. Their core business is not managing small rural health services, and it is people in my electorate of Lowan who are paying the price for that decision. I urge an urgent review of that because it is unacceptable for our people to miss out simply for an experiment that has not worked. If there are mergers that might happen that might bring in efficiencies, this is not one of them. It has cost more and our local people are getting less.

I would like to, just in my final minute and a half, go back to one of the key and core foundational things of our health system, and the member for South-West Coast just mentioned it. Hospitals are far more than just hospitals and somewhere you get treatment. They are more than somewhere you turn up in an emergency department or where you go and have a baby or visit a loved one and they provide support and care as you age and get older and are faced with a diagnosis which is difficult to deal with in the short-term – perhaps terminal – and you require palliative care. What is important about our hospital system is the care that you receive. Health care cannot be delivered without fabulous healthcare staff. It is the staff that provide the care. It is not the system, it is not the bricks and mortar and it is not the government of the day; it is the people who work within the healthcare system that provide that care. And so as I opened, I would like to acknowledge everybody who contributes to health care in this state. It is from the nurses to the doctors to the allied health professionals. It is the cleaners, it is the people who work in the kitchen, the people who work in accounts, anyone who answers the phone and the people who are responsible for the quality system, the occupational health and safety system. It is the people who are looking at doing things differently and providing a healthcare system that wraps around the patient rather than works in silos. I thank every healthcare worker for their contribution to Victoria’s health system. You deserve the support in every possible way to make sure you can do your jobs well and at the highest possible quality.

 Tim RICHARDSON (Mordialloc – Minister for Local Government, Minister for Consumer Affairs, Minister for Renters) (18:29): It is a pleasure to rise and speak on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2026, a really important reform that has been led by this Labor government, a Carroll Labor government that is putting working people first in everything it does. You can tell those shadow ministers who put in the effort and work, and I will acknowledge that the shadow minister does a heap, and without notes. She has a long history in health in rural and regional areas. While I might not agree with everything the shadow minister might put forward, she gave the level of depth and engagement that this bill is entitled to and deserves, so I acknowledge that significant contribution.

It is critically important that we support the healthcare workers that support Victorians in their time of need. Whether it is in maternal circumstances, where kids are going through and being born, all the way through to end-of-life care, it is health workers, it is nurses and it is our allied health services that are there each and every day. It is this Labor government that put nurse-to-patient ratios into law, enshrined them into law, to ensure that we support health workers into the future. Those opposite in a different time in government were very hostile to our healthcare workers. We remember the approach of the minister at the time in the other place David Davis and his approach to healthcare workers and how they approached paramedics, nurses and even the former Premier’s family in a show of disrespect to health workers who were just simply asking for better pay and conditions. Just recently they had a 28 per cent pay rise under this Labor government, valuing the work they do and respecting the work they do. They know that Labor governments invest in health care in every corner of our state, and this bill goes directly to that.

$109 million will be invested to uplift the classifications of 26 hospitals, including 17 in rural and regional Victoria. This means better care in our communities. This means that they must roster more nurses for the same number of patients, improving staffing and patient care. It was an announcement that was made by the former Premier and the former Minister for Health, and it was a significant moment for our communities and our state to see another additional investment in some 253 full-time equivalent nursing positions in our world-class healthcare system. Each and every budget we have seen increases in health investment, and we have seen increases in the support for the people that care for their fellow Victorians.

I am most happy and satisfied to see that the Victorian Heart Hospital, the only one in the nation, has also been uplifted. As Parliamentary Secretary for Health Infrastructure and as a south-eastern suburbs MP, I have had the chance to join Stephen Nicholls on a number of occasions and see the incredible work that is done by the Victorian Heart Hospital – the thousands of people that get that cardiac care and support, the incredible specialists, the surgeons, the clinicians and the allied health workers there. I have been joined by about a dozen colleagues over that time who have seen firsthand that the best of care, not just in Australia but internationally, happens right out in Clayton. The helipad on top as well means that someone can get that critical care after heart failure right away and be flown straight in to that important critical care. Health services like that and the list of health services across our communities in rural and regional Victoria and suburban areas and in the city are so important to the work that we are doing as a government to put health first.

It gives us the greatest of anxiety in government, as a Labor government, to think of the words that were uttered by the Leader of the Opposition only in 2024 as the Shadow Minister for Finance. When they say the quiet bit out loud, when they say that they will have to cut health and education, we absolutely believe them. The Shadow Minister for Finance, now the Leader of the Opposition, said that they would have no other option than to cut health and education. What are the first things those opposite go after when given the opportunity? They cut back on nurses and they cut back on teachers. So we have the greatest anxiety that under a Liberal–One Nation coalition, with a plan to cut $40 billion out of health and education, we would see nurse-to-patient ratios taken out and stripped back. That would lead to unsafe health outcomes, it would lead to poorer patient outcomes and it would be a degradation of the work that has been done over a decade to build up our health services further and provide the best class of care. Victorians cannot afford to go backwards, and they cannot afford a One Nation–Liberal coalition that would take $40 billion out of health and education. We just cannot see it.

I just think of all the work that was done – and I have had the opportunity to serve my community since 2014 – with the debate at the time around nurse-to-patient ratios. Those opposite were talking about whether it was going to happen and their opposition to our investment in health care and these critical outcomes. Then putting it into law and seeing celebration in this chamber, there was recognition that, as important as it was for the workers, it meant lives would be saved, because it means the gold standard of one-to-one nurse-to-patient ratios in intensive care units. It means improved staffing ratios in resuscitation cubicles and morning shifts in line with afternoon and night shifts in emergency departments. It means maternity services are safer, with a one-to-four midwife-to-patient ratio in postnatal and antenatal wards on night shifts, down from one to six, and in higher-dependency and coronary care units the introduction of an in-care nurse overnight. That builds on the legacy of nurse-to-patient ratios. That leads to safer outcomes, and that saves lives. It is not just a spreadsheet number on a cash surplus that is put forward. That is not any part of the plan that we see put forward, whereas the striving of those opposite to chase down a cash surplus will mean no additional investment in capital infrastructure in our state. It is an impossibility.

But at least I will give credit to those opposite. They do not deny that that is the case. When confronted with that in a point of debate or when asked about it in the media, I give them credit that they do not deny that that is actually the plan. So Victorians will have a clear understanding that nurse-to-patient ratios going forward into the future are a choice. Do we want to see more investment in our nurses? Do we want to see the protection of nurse-to-patient ratios, which have protected lives and improved patient outcomes and care? When your child’s temperature is at 41 and you are wondering what is going on, or you do not know whether you are going to call an ambulance, front up to the emergency department or go to the urgent care clinic – those things exist at safer standards today because Labor governments have invested in health care. Those things are at risk with cuts to healthcare workers – cuts at the level of $40 billion into the future. That puts patient care at risk. We will fight that as a Labor government every single day up until the election, because that is what is at stake coming into this election: cuts to health and cuts to education, or investments like this, an additional $109 million to strengthen nurse-to-patient ratios across our state and uplift some 26 hospitals as well.

I am really proud to see some of the investments that we are making in health across our state. We see significant investments with the support for Peninsula University Hospital, such a regional facility, with a helipad as well. There is some $1.1 billion of investment there, with more beds, an expanded emergency department, a great paediatric ward, a great mental health facility and better support for oncology. I literally came up Boundary Road today, Clayton Road, and saw the Monash Medical Centre coming out of the ground. The investment there that has been made is substantial. That is a $550 million-plus investment by this Labor government. Just the other day I was going into the Deputy Premier’s electorate, where the Dandenong Hospital expansion will be substantial.

So we give a shout-out to all those nurses and those midwives. There are 17,000 more of them because this Labor government has invested in health care, and they now have a job that did not exist a decade ago. That is the investment that Labor governments make. We are all about putting patients first, supporting working families and taking a new direction under this Carroll Labor government. When it comes to investing in health and when it comes to supporting our nurses, nurse-to-patient ratios will be on the ballot, and it will be a choice between cuts or investment in health.

 Rachel WESTAWAY (Prahran) (18:39): I rise this evening to speak on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2026. Let me be clear at the outset: the Liberals and Nationals will not oppose this bill. We support its intent, but there are so many things that we think need to be considered. First of all, we support its intent because it is about safe care for patients and more support for our nurses and midwives. That has been our position on every ratio amendment since the original act in 2015. Safe staffing is not a partisan idea. When there are enough nurses and midwives on the floor, patients are safer and care is absolutely better. This bill implements the government’s hospital classification review, which used each health service’s own data to weigh workload capacity and patient complexity and then reclassified hospitals to match. In total, 26 ‍hospitals moved to a new classification, and 17 of them are in regional and rural Victoria. Those are absolutely welcome commitments, and I acknowledge them.

Let me start with my own community, though. The Alfred on Commercial Road, in the seat of Prahran, is a major hospital for the people of the seat of Prahran, and it serves patients right across the state, as we all know. It is one of the only two adult major trauma centres in Victoria. It runs one of the busiest emergency departments across the state, and it operates the largest intensive care unit in the country. My constituents rely on it every single day. The Alfred is already a level 1 hospital, and it is not one of the hospitals reclassified in this bill. But that does not make this bill irrelevant to the seat of Prahran, and I will explain to you why it is actually far from it.

When regional and metropolitan hospitals are properly staffed, fewer patients need to be sent to centres like the Alfred, and the pressure on those centres then eases. It is logical: a better-staffed system everywhere is a safer system for my community. So I welcome the intent of the bill, and I welcome what it means for nurses and midwives across the state. I particularly welcome the changes to emergency department categories in schedule 3 that the bill refers to. Departments like those at Echuca, Wangaratta, the Eye and Ear, Sale, Swan Hill, the Royal Women’s, West Gippsland and Wonthaggi are all reclassified, and that is the right thing to do. It recognises the acuity these departments now deal with and the staffing they genuinely need. That recognition is overdue, and it is absolutely welcome. But recognising the need for staff is one thing; finding those staff is absolutely another thing. A reclassified emergency department now has to find nurses to meet its new ratio. So, I put a simple question to the government: where are those staff actually going to come from? This is not an abstract worry. The evidence on the emergency department floor is absolutely confronting.

In its 2025 Breaking Point report, the Australasian College for Emergency Medicine found that 91 per cent of ED directors had seen a violent incident in the previous week and that in 79 per cent of cases that violence was physical. The College of Emergency Nursing Australasia has highlighted the connection between the system pressures and violence in emergency departments, and its president, Associate Professor Kelli Innes, says that these are not isolated incidents. They are, in her words, symptoms of a system under strain. When patients wait longer and staff are stretched, the risk of violence rises further. The data bears this out. Across the country, assaults that put healthcare workers in hospitals have more than doubled in a decade. In Victoria, even after recent gains, only about 68 ‍per cent of ambulance patients are handed over within the 40-minute target, well short of the 90 per cent goal. Barely half of ED patients are through the department within four hours. These are not conditions that help us attract and keep experienced nurses; they put them under enormous pressure.

That brings me to a specific gap in this bill: it demands more specialist nurses in our emergency departments and intensive care units but it does nothing to fund the training that produces them. This is a key issue of mine. An emergency department relies on two skills every hour of every day: acute triage and confident resuscitation. Neither is learned by osmosis. Triage must be performed by a specially trained and experienced nurse working to the national standard, the emergency triage education kit. Yet the Department of Health does not fund that triage training, and it does not fund resuscitation or advanced life support courses either. A nurse who wants postgraduate emergency qualifications faces course fees of up to – listen to this – $14,000. Very often they pay that themselves and study in their own time. There are a few state scholarships, but they are capped below the cost of the course. It is rationed by individual health services, and it does not fund short courses like triage or resuscitation at all. And too often this training comes straight out of a nurse’s own back pocket. You cannot legislate for a specialist workforce and then ask nurses to pay for their own training in that specialisation. It is absolutely ridiculous. This matters because the evidence that better training means better outcomes is absolutely overwhelming. A landmark study, published in the Lancet in 2014 –

The ACTING SPEAKER (Wayne Farnham): Member for Prahran, I ask you to talk through the Chair, please.

Rachel WESTAWAY: This matters because the evidence that better training means absolutely better outcomes is overwhelming. That landmark study was published in 2014 across 300 hospitals, and it found that every 10 per cent rise in degree-qualified nurses cuts the risk of a patient dying within 30 days by 7 per cent. Formal triage training sharply improves the accuracy of triage decisions and better triage saves lives for the most time-critical patients, and isn’t that what we are all about? Advanced life support training improves a patient’s chances of survival from a cardiac arrest, and better trained nurses save lives. That is not an opinion; it is absolutely evidenced in everything that we read. When nurses have to fund their own training or go without it, it is the patients who bear the cost. This bill recognises the acuity, but it must now fund the workforce that goes with it.

The same logic applies in intensive care. The Australian College of Critical Care Nurses sets a clear standard: at least half of the nurses giving direct care in ICU should hold a postgraduate critical care qualification, and ideally three-quarters should have that. That is the difference between a number on a roster and a safe intensive care unit. The college supports this bill, but it gives a warning that adding staffing numbers without more trained critical care nurses simply leaves senior posts empty and spreads experienced staff far too thin. It takes years to develop an expert critical care and emergency department nurse; a ratio on paper does not.

Here is the hardest part to reconcile. At the very moment this bill increases demand for nurses, more than 2000 graduate nurses and midwives are set to miss out on public places in 2026. The government made it free to study nursing, but, you know what, they cannot get jobs. Enrolments rose, but the graduate jobs did not follow. We are turning away the very people we need to staff these ratios, and it is the graduates in regional and rural Victoria, exactly where 17 of these reclassified hospitals sit, who will feel it the most. None of this is a reason to oppose this bill, however, and we do not, but it is every reason to press the government when this bill reaches the Legislative Council. My colleagues will do just that. They will ask whether $109.7 million is really enough or whether hospitals will be forced to backfill with costly agency nurses at the expense of planned surgery. They will ask what workforce planning is underway so that the right nurses and the right skill mix are in place when these changes start, and they will ask how well the system is meeting the current ratios.

A Wilson Liberals and Nationals government will always stand behind frontline workers – the nurses, the midwives who care for us and those that care for us at our most vulnerable times. The coalition supports safe patient care and we support this bill, but we will hold the government to account, we absolutely will, because what is promised on paper must be delivered at the bedside for those nurses and midwives.

 Pauline RICHARDS (Cranbourne) (18:49): I am so very pleased to have the opportunity to speak on this absolutely extraordinary piece of legislation, the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2026, and I do so proudly because this is a bill that speaks to Labor values, it speaks to Labor history, it speaks to Labor action and this is a Labor story. I am delighted to hear that the Liberal Party are not opposing this legislation, and I look forward to its passage. There are discussions in the other place about any questions they have and any amendments that they seek to make, but I am delighted to hear that this time at least it looks like this will have an appropriate passage through the Legislative Assembly.

This bill amends the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 to update the hospital categories in schedules 1 and 3. In 2015 I was working in the previous Minister for Health’s office when this legislation was first in its genesis, and I am going to take the opportunity to reflect on the history of this bill and what it was like to have a gallery full of members of the Australian Nursing and Midwifery Federation (ANMF) – members of our important union – here, who celebrated at the time the passage of a piece of Labor legislation that speaks, as I said, to Labor values. In the time since the legislation was introduced in 2015 it has been updated over time. Of course Victoria has changed: hospitals have grown, communities have grown and patients presenting to our hospitals today have more complex needs than they had when these categories were first drawn up. So this bill has a legislative framework that looks to our community’s reality.

I am going to, on indulgence, take a moment, though, to congratulate the new Minister for Health and say how delighted I am that Ms Stitt is taking over what is an incredibly important piece of government infrastructure policy work, and having the combination of health and mental health together I think speaks to this government’s priorities. So congratulations to Ms Stitt in the other place. I am very pleased to have been appointed her parliamentary secretary and am very much looking forward to working on what is I think one of the most, or the most, important areas of policy reform – no offence to the other important policy wonks who are here with us now. I would also like to acknowledge the work that was undertaken by Ms Shing to bring this legislation here, and of course the member for Macedon, who is going to be able to look back on the time she spent as the Minister for Health and reflect on the important changes that she undertook. While I am at it, I am going to acknowledge as well the previous member for Albert Park Mr Foley for the work that he did, especially during very difficult times.

Of course, in this particular instance I am going to reflect on the previous member for Altona, who did initially navigate the first tranche of nurse-to-patient ratios. As I said, I was working in the then Minister for Health’s office at the time when the safe patient act was first introduced, and I can say that in this chamber it was not a piece of legislation that was introduced with the full-throated support that I anticipate will be experienced now. The Honourable Jill Hennessy worked shoulder to shoulder with the secretary of the ANMF at the time, Lisa Fitzpatrick, on navigating the best outcome for our health care. Now we have an amazing leader in Maddy Harradence, who is now the secretary of the ANMF, and as always, I am in awe of this extraordinary union under the guidance of Ms Harradence. When nurses speak, our Labor government listens. This bill proposes that 26 hospitals across Victoria, 17 of them in rural and regional Victoria, will be recategorised to a higher level. This is not a technicality; this means that more nurses will be rostered on.

This bill is personal for me in other ways as well. I have a family of nurses that I often reflect on. My brother, my sister, my cousin, my dearly departed mother-in-law, my niece and my aunty are all nurses. We had the census last night, and I always ask the members of my family who are still nurses, even if they have a tendency to push a pen and spend more time with their laptops and computers these days, ‘So what do you call yourself? What job do you have?’ I am advised by my beloved brother that he still considers himself a nurse. Even though he spends more time in front of a keyboard and more time with a pen in his hand, he keeps his registration up to date. Nurses identify as nurses, and I am very grateful to the extraordinary nursing and midwifery workforce that I have in my family.

Again, this bill did not come from nowhere; it is the product of a genuine hospital classification review. It was developed in close and ongoing consultation with the ANMF, the Victorian Healthcare Association and other healthcare service leaders. This is evidence-based reform, and it is reform that is built by the people who do the work. What a contrast to those opposite. I was surprised to hear the member for Prahran spruiking the policy proposal that was put up earlier this week, because like some others here in this chamber, I did end up watching a little bit of the media review and the media reporting of the alternative Minister for Health Ms Crozier from the other place as she outlined the consultation that was undertaken before announcing their grand policy package this week. It was really interesting to reflect on the consultation that was undertaken. How many of the hospitals that were impacted by the Liberal Party’s proposed legislation were consulted? Some of the hospital management were consulted. How many exactly? One. But it is okay because the member for Berwick was consulted. I am not sure if the member for Berwick has a deep understanding of the work that is undertaken in our hospital settings, but certainly in the pressure cooker environment of a press conference the member for Berwick was cited as the person with the expertise in what should happen in an emergency healthcare setting.

This bill does not stand alone; it sits within a track record of Labor standing up for nurses, midwives and the patients who depend on them. I am going to take a moment to reflect on the other reason why this legislation is personal for me, and that is because Cranbourne, Clyde North and Cranbourne East are home to the largest number of nurses in the state. I am, with your indulgence, going to take an opportunity to thank the extraordinary nurses and midwives who are employed in our healthcare settings and who live and reside in my electorate. Thank you. Your work matters. We listen to our nursing and midwifery workforce, our clinical workforce. We value nurses and midwives. Our nurses and midwives deserve our respect, they deserve their pay rise and they deserve to have nurse-to-patient and midwife-to-patient ratios.

Cranbourne is home to one of the fastest growing communities in the state, but it is difficult for me to get up and speak about health care without reflecting on what happened last time the Liberal Party held the seat of Cranbourne. If the member for Melton were here, I would be able to reflect on his booming voice as he would remind us that last time the Liberal Party held Cranbourne they privatised the ambulance service. We know Mrs Hermans in the other place, a member for the South-East Metropolitan Region, has told many people – I understand it is on the record here – that the Cranbourne Community Hospital is not a real hospital. Well, they are a real workforce. Those who work in the Cranbourne Community Hospital tell me that they do real work every day, whether it is ophthalmology, dental, dialysis or in the mental health system. This is a real hospital, and the clinicians and the nurses who work in Cranbourne Community Hospital are real workers. Every shift, every patient gets the care they need. That is why Labor is different. We know that a One Nation–Liberal–National coalition government, if given the opportunity, will privatise the Cranbourne Community Hospital. They have said the quiet bit out loud. This is all at risk.

This bill before us acknowledges the work of our nursing and midwifery patient workforce. It acknowledges that a Labor government puts nurses and midwives – our workforce – at the centre of our legislative agenda. We know that this is the only way to make sure that people get the care they need. I commend the bill to the house.

 Roma BRITNELL (South-West Coast) (18:59): We have six fabulous hospitals in South-West Coast: Port Fairy, Terang, Heywood hospital, Portland hospital, Warrnambool Base Hospital and St John of God hospital. The staff at those hospitals do a fabulous job of looking after our community right across the South-West Coast. Hardworking nurses, doctors, allied health professionals, from the kitchen staff to the cleaners –

The DEPUTY SPEAKER: Order! I am required by sessional orders to interrupt the member, who will have the call when the matter returns to the house.

Business interrupted under sessional orders.