Wednesday, 8 February 2023

Production of documents

Health workforce

Georgie CROZIER (Southern Metropolitan) (10:15): I am pleased to be able to rise and move my motion, which is on the notice paper as motion 3. I move:

That this house, in accordance with standing order 10.01, requires the Leader of the Government to table in the Council, within 14 calendar days of the house agreeing to this resolution, a copy of any and all briefings provided by the Department of Health or any other department, agency or public official to the Minister for Health and/or the Premier, from 1 July 2022 to date, concerning staff shortages in the public health system.

This is a very simple documents motion. It relates to a very important issue that is facing our state – as I have been speaking about for many, many months – around the staff shortages in our public health system and the issues that are arising that are affecting Victorian patients and their families and are impacting those medicos that are treating them and managing their conditions and everybody involved in their care.

It is a really important motion that I am putting to the house today, because what we know is that there are staff shortages. The government’s four speakers are going to stand up and go on about this being a once-in-a-100-year event with the pandemic and it being a global resource issue. We know that. Everybody knows that COVID hit the world, hit Australia, but here in Australia, Victoria was the worst affected. Out of any state or territory it was Victoria that had the harshest of restrictions and the worst impacts to all Victorians, and that has ricocheted around the country, no doubt. But it is critical if we are to fix this health crisis that is absolutely getting deeper that we understand the true depth and that we have the transparency to understand exactly what the government was briefed on about these staff shortages.

Why I talk about this is because as a former nurse and a midwife who has worked in some major metropolitan hospitals I understand the challenges of rostering and how it can impact the delivery of care. Of course I have never experienced what healthcare workers – nurses and doctors and everybody else involved in our public health system – have experienced over the last few years, which has been extraordinary, and I want to just pay tribute to all those that have done the work over the last few years. Nevertheless there are nurses that speak to me and tell me about the numbers of people that are leaving our public health system – and they are leaving in their thousands – and we need to understand the depth of experience that is left.

I have spoken about the need to understand what is happening around our state, the gaps in our health system, so that we can actually address those, work with the federal government to fast-track visas to get nurses or doctors or allied health professionals into those areas. What we are seeing around regional Victoria is a severe shortage. I was recently in Narracan for the election that occurred there, and while I am talking about that, can I put on record my congratulations to Wayne Farnham, who had to front up a second time after the new election that was required. But nurses were speaking to me, and one nurse from Gippsland came up to me and said, ‘I’m telling you: experienced nurses are leaving our emergency department.’ So what is the depth of the problem? We need to understand that, and that is why I am saying that we need to have those briefings in the interests of all Victorians.

We know that this health workforce shortage is a massive challenge for government. I acknowledge that. I am not disputing that it is not a challenge, and I have great concerns about how the government is going to meet what they have said they are doing. I say that because just a few weeks ago the data that was released showed that more than 10,000 healthcare workers resigned from public health services in Victoria in 2021. Now, this was in the height of the pandemic, but those 10,000 are a massive loss to our health workforce. That is a rate of health workers resigning of more than 200 a week. You take those people out of the system and you are going to have massive issues. The government is papering over it. I have no doubt that government MPs will stand up and say, ‘We have done more than anyone else in the history of mankind, recruiting more nurses’, using their usual spin. They will say, I have no doubt, that they have recruited 26,000 public healthcare workers since 2014, including more than 8500 during the pandemic. That 26,000 over the past eight years equates to around 3000 a year, but we are losing 10,000 a year at more than 200 a week, so the figures do not add up.

We must understand the depth of this crisis. This is a simple documents motion. I do not need to say much more. I do not want to waste the chamber’s time in saying too much more, but I do want to say that we know those resignations continued from 2021 into 2022, and the government has a commitment to provide around 22,000 healthcare workers in the next three years to the health and community health sectors – 22,000. That is a significant number when we are losing them at the rate we are. It is going to be a massive challenge. That is why I think we need to understand the briefings that were provided to the minister and to the Premier about this issue. Now, if they have not had briefings, fine, then tell us. If they had those briefings, then release those documents.

I know, and Victorians know, that the government has an issue around transparency. We all know that. We have seen it over many years, the lack of transparency and the spin that this Andrews Labor government continue to provide, but I think Victorians have had enough of that. This is a new term of government and Victorians deserve to understand exactly what the status is in relation to the numbers that are leaving the system, the numbers that have left and where those gaps are, not just who they are recruiting. Numbers are numbers, but we need to understand what those numbers are. What is the experience? Where are they leaving from? Are they leaving from one particular area? Let us have a look at that. I am sure the government has that detail from briefings. If they do not, then that is another question and I would ask why that has not occurred.

This is a simple motion. I hope the government considers it and that we get this motion passed through the house as quickly as possible.

Sonja TERPSTRA (North-Eastern Metropolitan) (10:24): I rise to make a contribution in regard to this motion on the notice paper moved by Ms Crozier. I note that what it requires – it is a standard documents motion, of course – is:

… the Leader of the Government to table in the Council, within 14 calendar days of the house agreeing to this resolution, a copy of any and all briefings provided by the Department of Health or any other department, agency or public official to the Minister for Health and/or the Premier, from 1 July 2022 to date, concerning staff shortages in the public health system.

Our government has a proud record in regard to our health system. At the outset I just want to make it clear that it is our government that supports not only making sure we have a properly funded healthcare system but also our healthcare workers. We have some amazing, dedicated professionals that work for the public in Victoria every single day, and I would just like to thank everybody who works in the health system for their tireless dedication and work in the health system in the incredibly challenging period that we know we have all just been through with the pandemic.

Our healthcare workers are amazing, and I can say I have had the benefit of listening to Ms Crozier’s contribution and I know Ms Crozier’s background as a nurse. But also before I came to this place I worked for the nurses union – the Australian Nursing and Midwifery Federation, Victorian branch – and it is a titan of a union. It is a very strong union and it is I think probably one of the largest unions, if not the largest union, in Victoria, and that is because our healthcare workers – our nurses, our midwives – know that the protection that is afforded through that union, the good work that that union does to help nurses and midwives in their workplace and the advocacy that the union does on behalf of its members are amazing. It was an enormous privilege to have worked for the nurses union, and I just want to shout out to the leadership of the union, particularly Lisa Fitzpatrick and Paul Gilbert, who are amazing and provided amazing leadership for that union.

Returning to the motion, I just want to talk a little bit more about it, because this is a targeted motion. It is particularly seeking documents around concerning staff shortages in the public health system. One thing I know and that is obvious and apparent when you work in the health system is that there are always people who come and go in the health system. Working as a nurse or a midwife in the healthcare system is a very challenging role, but it is an extremely rewarding role as well. I know that, even in my role as a member for the North-Eastern Metropolitan Region, nurses and healthcare workers who speak to me every day acknowledge and thank the Andrews Labor government for the support and the funding that we have put into the healthcare system.

I will note for the record, just as an example, that we have invested in a $270 million nursing and midwifery package that will see 17,000 nurses and midwives recruited and trained and a $3000 retention payment for every worker in our health system. What we have done is targeted where we know that there are staff shortages, and those things have been announced and well ventilated. We know that these challenges existed even before the pandemic, and then when the pandemic hit it brought these things into sharper focus. Also, those investments in the healthcare system are on top of our $12 billion pandemic repair plan. We will be training or hiring up to 7000 healthcare workers, including $59 million to support more than 1125 registered undergraduate students of nursing to enter the workforce each year over the next two years.

So really, when Ms Crozier talks about shortages – and I learned this when I was at the nurses union – you cannot just snap your fingers and say, ‘Hey, let’s get some more nurses on board.’ It is a pipeline, and you need to make sure that the pipeline provides those workers, because it takes years to train healthcare professionals. You cannot just plonk someone in. I know even students have to be supported in the workplace and they have to be mentored and tutored by experienced nurses and midwives. So this is a pipeline issue and it has always been an issue, but as I said, the pandemic has brought this into sharper focus. Also, there is $9.8 million to deliver 75 registered undergraduate students of midwifery each year over the next two years; $5.6 million to allow an additional 288 graduate enrolled nurses to hit the ground running in our hospitals, with dedicated supports that they need; $4.6 million to help allied health professionals transition into advanced practice roles; $1.5 million to support Aboriginal health students and cadetships, scholarships and training support; and $15.7 million for 400 additional perioperative nurses and to upskill up to a thousand nurses and theatre technicians. We are also turbocharging our international recruitment efforts to employ an extra 2000 international and expat healthcare workers. There are so many more things that I could go on with –

David Davis: On a point of order, President, as the member said, there are so many more things she could go on with, but actually it is a very, very narrow motion. It is a documents motion.

Sonja TERPSTRA: Did you listen to Ms Crozier’s contribution?

David Davis: I did. As the member is now going off into training and TAFE and a whole range of things, all of which are very interesting points –

The PRESIDENT: Mr Davis, there is no point of order.

Sonja TERPSTRA: Thank you, President. I might say I was waiting to see, Mr Davis, what grounds your point of order was being made on, but they did not emerge. So I will continue with my contribution as I was going to.

Since 2014 we have invested record amounts in our healthcare workforce, including nearly 4000 more doctors, which is a 44 per cent increase, and nearly 10,000 more nurses, which is a 27 per cent increase. I know there are other speakers who are going to speak on this motion, and I am watching the clock, which is running down right now. But you can see just in the small contribution that I have made how I have highlighted the massive and record investments in our healthcare system.

I know other speakers will probably go to some of the technical aspects of the documents motion, but I just might focus on and point out some of the failings of the Liberal government over there: 1300 beds in 12 hospitals were closed by Kennett, and there was the closure of our state’s special infectious diseases hospital in Fairfield – which kind of became pretty important during the pandemic, I would have thought. It waged war on paramedics and refused to negotiate.

David Davis: President, on a point of order, this is a narrow documents motion, and the member is now into discussing a government in the 1990s, which has nothing to do with these documents.

The PRESIDENT: There is no point of order.

Sonja TERPSTRA: And more than a billion dollars were cut during four years in office. So again, for the Liberals to come here today, for the opposition to come here today and to try and cast this motion in a way that suggests we are trying to hide something, we are underinvesting and our healthcare professionals and our healthcare workforce are very disappointed and upset with us – I have never heard anything more ridiculous.

I also note they promised only $83 million towards the redevelopment of Ballarat Base Hospital at the 2014 election; there were 73.7 per cent code 1 incidents within 15 minutes in 2013–14; and they refused to release quarterly response times over the last 18 months of the term. So again, I am trusting that other speakers will go to some of the ridiculous approaches that the coalition had on documents motions, because particularly it is this government that, if you look at our record in terms of releasing documents, consistently releases documents when they are requested. Those opposite when they were in government had a very poor record of cooperating and releasing documents. So for the opposition to say that we are either hiding things or whatever it is – I do not even know; the sense was not really a coherent kind of stream there. But again, to try to say that we are underinvesting or not on top of workforce planning and the like is really kind of – wow, I do not even know what you could call it, but it is quite ridiculous. Nevertheless it is something that this government is acutely aware of, and we have done a lot of work around workforce planning and retention.

We have also further invested $353 million in the winter retention surge and payment. So you can see all of these payments are targeted towards making sure that we can retain the most experienced and qualified staff but also attract more people into our healthcare system, because as I said, when I worked at the nurses union one thing was apparent, and this has not changed over time: there is a churn in our healthcare system. That is normal; that is what happens. The pandemic obviously brought that into sharper focus, so we have made sure we have targeted our investments to supporting our healthcare workforce – our most important nurses, our midwives, our amazing healthcare workers and our allied healthcare workers who work in our hospital settings each and every day, working to protect and help Victorians when they need it the most: when they are in hospital and acutely ill.

I will leave my contribution there. I look forward to hearing the contributions of other speakers, particularly around the record of those opposite and how poor it was.

Sheena WATT (Northern Metropolitan) (10:33): I do like talking about health – I truly do – so this is a great opportunity, and thank you to Ms Crozier for putting this motion up for discussion here in our chamber. I am delighted that the first thing I am speaking about here is in fact health. Of course I want to begin by acknowledging our health workers for all that they do. Since the very beginning of the pandemic you have been on the front line in some extraordinarily tough conditions and under extreme pressure which none of us could ever, ever have imagined in the years before.

I have talked about it a number of times and I will say it again: I have spent most of my adult working life in health organisations and community organisations, and I have seen firsthand the extraordinary work of our clinicians and practitioners and will take a moment to thank some doctors, nurses and health workers but give a particular shout-out to the Aboriginal hospital liaison officers for all that they do. You are out there on the very front line.

David Davis: On a point of order, Acting President, this is a narrow documents motion, and the member has indicated that she wants a broad health debate. It is not a broad health debate; it is a motion about the provision of documents to the chamber. It is not a motion about broad matters. She began by saying she would like to talk about health in the broad and welcomed the chance to talk about health on a wide front. It is not a wide front motion; it is actually a very narrow one under standing order 10.01.

The ACTING PRESIDENT (Sonja Terpstra): Thank you, Mr Davis. I note your point of order. However, I will direct your attention back to Ms Crozier’s opening remarks. There is no point of order there, but I will encourage Ms Watt to get back to addressing the point.

Sheena WATT: I will go back to that, but can I take a moment to acknowledge Acting President Sonya Terpstra and offer to her my congratulations and best wishes as she takes on this very challenging new role. I am sure we can all agree that it is a tough gig up there in the chair, so all the very best to you, Ms Terpstra, as Acting President. I will try now to take into consideration what you are saying, which is that I bring some of my remarks back to this being a documents motion.

It is true that the government takes a number of considerations into account when looking to release documents. These include whether or not the documents referred to in the said motion would prejudice legal proceedings; prejudice intergovernmental and diplomatic relations; materially damage the state’s financial or commercial interests, such as if there is a tender or there are taxation policy issues; prejudice law enforcement investigations, national security or indeed public safety; or otherwise jeopardise the public interest on an established basis – in particular, where the disclosure would. Of course there are also considerations as to revealing confidential legal advice to the executive government; revealing information obtained by the executive government on the basis that it be kept confidential, including because the documents are subject to statutory confidential provisions that apply to our Parliament; and revealing directly or indirectly the deliberative processes of cabinet. There are considerations that are made by the government when it comes to documents that may reveal high-level confidential deliberative processes of the executive government or otherwise generally jeopardise the necessary relationships of trust and confidence between a minister and public officials.

This being, I believe, our first documents motion of this Parliament, it is worth outlining those considerations for the chamber, particularly when we have a number of new members that may be interested to know and understand what some of the considerations of our government are when it comes to documents motions. These are a somewhat frequent feature of our Wednesday debates, so I hope that you will know and note that.

Of course the Andrews Labor government has a really proud history of a range of transparency bills, actions and activities, including some bills that have been supported by our government in the past, including the Transparency in Government Bill 2015, which came about in the earliest years of the appointment of the Andrews Labor government; the Integrity and Accountability Legislation Amendment (A Stronger System) Bill 2015; the Parliamentary Budget Officer Bill 2016; and the Family Violence Reform Implementation Monitor Bill 2016. I was personally involved in some of that work through my work with the Royal Commission into Family Violence, and I note that that is a quite strong and powerful act in its work in reform of our family violence sector. Of course there are also others that may be of note to members, including the Integrity and Accountability Legislation Amendment (Public Interest Disclosures, Oversight and Independence) Bill 2018 and then the Integrity and Accountability Legislation Amendment (Public Interest Disclosures, Oversight and Independence) Bill 2019. So there you go; there are some bills that we have moved with respect to transparency.

I wish that that was in fact a track record that I could say our government built on from the previous government, but the truth is that in the 57th Parliament the Legislative Council passed six documents motions, the at-the-time LNP government responded in part by providing documents in part for three of those six documents motions and the LNP government provided no documents for 50 per cent of those motions. I will just repeat that, because it bears repeating: the LNP government responded in part by providing documents in part for three of the six motions and provided no documents for 50 per cent of those motions. I would like that noted and known to the chamber, and I may from time to time repeat that as we continue to debate documents motions here in the chamber.

No documents at all were provided in response to requests by Labor seeking orders for documents on ambulance response times, Patrick stevedores’ relocation and the east–west link business case – for which just an executive summary was released, which contained none of the details of the project. In the 57th Parliament the LNP left 1174 questions without notice unanswered. That is quite an extraordinary number, and it is nearly double the amount of questions without notice unanswered by Labor in the 58th Parliament. So there you go. This is just some of the history of documents motions and some of the considerations that the government does make when considering documents motions here before our chamber.

I am going to go back and take the last little bit to discuss some of the opening remarks of the mover of the motion, Ms Crozier, which were about – what was it? – health and data and statistics, and I could go on for days, frankly, about the Andrews Labor government’s commitment to health, what we have done in the last term and the commitments that have been made. But there is one thing that stands out for me – and there are just so very many. That is of course that there are nearly 700 highly skilled and highly sought-after internationally based healthcare workers who have touched down here in our state and helped boost our frontline health services right across regional and metro Victoria. These doctors, nurses, midwives and allied health professionals are making a huge difference on the ground. I know that because I live in their neighbourhood. I live right near Royal Melbourne Hospital, Royal Children’s Hospital and the Parkville precinct – some of the best researchers in the country – and we are very, very lucky to have them here in our country in a very challenging time. So I look forward to continuing to champion them and their efforts in our community.

Michael GALEA (South-Eastern Metropolitan) (10:44): Thank you, Acting President Terpstra, and may I say as well how wonderful it is to see you sitting in the chair there. I am very excited to be speaking on my first motion as a member of this council and thank the Honourable Ms Crozier for bringing it to our attention. It has been quite a busy few months since the last election, and I know we are really raring to go. There are a number of things underway specifically in relation to the health portfolio that this government has already achieved and will continue to achieve in our third term.

I would like to begin by talking directly about our health workforce. Our health workforce day in, day out do an amazing, amazing job. Obviously, as many have said previously, they do an incredible job; they have done an incredible job specifically around the pandemic. However, every day in good times and bad our health workers go in, day in, day out, doing hard work, looking after Victorians when we need them the most, and I do want to join all Victorians in thanking them for that. Obviously, those are the ones that we hear about lots – the nurses, the ambulance paramedics and the doctors. But there are also the lesser recognised health workers – the patient service attendants, allied health professionals, ward clerks and all of them – so I do want to acknowledge them. As Ms Crozier referred to in her opening remarks, yes, the pandemic has absolutely thrown our health system – many health systems around the world in fact – a real curveball, and this government is rising to the challenge of fixing our health system, as we need to.

In terms of staffing, there have been a number of initiatives already that have taken place. Of course, as other speakers have referred to – and I believe you, Acting President Terpstra, referred to – the $270 million nursing and midwifery package will bring 17,000 nurses into our system, and there are also the $3000 retention payments for nurses. I think it is not just important of course that we acknowledge bringing new staff into the system, as many in this debate have already said; it is vital that we actually retain the staff that we do have and that we retain the experience that they have as well, which is frankly invaluable.

There were a number of points raised in relation to this documents motion, and I would like to address a few in brief. I would like to pick up as well on what my colleague Ms Watt just said in relation to ambulance response times. Under the 57th Parliament, the last time those opposite were in government, a number of motions, as Ms Watt said, were completely rejected for the provision of documents. One of those motions was to do with ambulance response times, and that is something that directly goes to the heart of staffing in our health system. Many of us would be aware – certainly many of us in this chamber are very aware – that during those years from 2010 to 2014 ambulance response times were at their worst on record and the worst in the country as well. It was up to the Andrews Labor government in our first term, from 2014 onwards, to address that issue, and that is exactly what we did. Ambulance response times in Victoria went from the worst in the country to the very best in the country, and now that the system has been facing more challenges through the pandemic, we are doing the absolutely essential work of bringing that system back up again. The reason my colleagues in the house can be confident that that will happen is because we have done it before and will do it again.

It is particularly interesting to note I think that whilst they were in government those opposite refused to actually provide any answers on ambulance response times or indeed the staffing situations which led to it. Indeed there were some very disheartening comments made at the time by those responsible, calling paramedics thugs. They called them hardline. They said that they were exploiting the crisis. But there was a crisis that they refuse to ignore.

This is a government on this side of the chamber that is absolutely committed to providing the support our ambulance system needs, and that is evidenced through the fact that over the past eight years of our terms in office we have actually increased dramatically the numbers of Ambulance Victoria’s workforce by more than 2000 more paramedics, which is a 56 per cent increase from the time that we came into government.

I would also like to note that there is a lot of investment going on across the state that this government has been delivering and will continue to deliver that is going to directly influence the staffing levels and contribute to better patient outcomes as well as better staff outcomes. It was this Andrews Labor government that brought in nurse-to-patient ratios. There were absolutely none under the previous government. In 2015 we brought in those patient ratios, and in 2019 we strengthened them. Only this side of the chamber will continue to do what is required to support our working staff in hospitals and in other healthcare settings.

There are a number of other commitments that we have made during the last election that will continue to see our hospital system be strengthened and supported. In my region alone there will be the upgrade to the Dandenong Hospital – $295 million – and a bigger and better Monash Medical Centre, with up to $560 million of funding. There is also going to be just outside my region a brand new hospital for West Gippsland. About two years ago my partner suffered a health issue. Thankfully he is okay now, but we went as quick as we could to Warragul hospital, and great hospital though it is – the staff were absolutely fantastic – the condition of the building was perhaps a bit dated, shall we say. Only this government is going to invest by building a brand new hospital in West Gippsland, in Drouin East, and that is going to be wonderful. That is a community that is growing enormously as well, and it is one more example of the way that we are supporting the health outcomes of Victorians right across the state. Of course there are a number of projects already delivered in my region as well, such as the upgrade of Casey Hospital, such as the upgrade of Frankston Hospital and also, just outside my region, stage 1 of the Wonthaggi Hospital, and stage 2 of that will be coming along very shortly under this term of the Andrews Labor government.

There are also a number of initiatives that we are undertaking for retention of our healthcare workers. That includes a $5 million package to expand the nation-leading worker wellbeing centre, expand the nursing and midwifery health programs to provide one-on-one psychological and physiological supports for more nurses and midwives and expand the doctors health program too to make sure that our doctors, our junior doctors and our specialists have the supports they need and that they get them when they need them.

It is also worth mentioning that in the context of health this is an area where we do have some overlap with our federal colleagues as well. That is why we have also announced that we will be supporting our GPs through a $32 million investment to incentivise our doctors, especially our new doctors, to become GPs, offering financial services and incentives for them to do so by enrolling in the GP training program. We have had nine years of underinvestment from the Morrison government and previous Liberal governments in Canberra, and that has put increased pressure on our health system here in Victoria, as it has right across the country. It should not be up to the states to do that, but that is an investment that we have made because those on this side of the chamber believe in putting the health outcomes of patients first and delivering those health systems for all Victorians and getting the best possible outcome. We do hope that with the Albanese Labor government we will be getting some better outcomes for our GPs there as well, which will obviously have flow-on effects through our emergency departments, through our hospitals and through our ambulance services as well. So there are a number of other initiatives there that we will be making, and we will be continuing to look at approaches that we can take to improve the health situation in Victoria and to improve the staffing levels. As I said, we are the only ones on this side of the chamber who have the track record of investing in nurse-to-patient ratios and in the support of those things as well.

We have also done a massive generational boost to paramedics. That is through the investment of $16 million for an additional 40 mobile intensive care paramedics – 40 MICA paramedics. It is also through the $20 million towards paramedic practitioners, which will be transformational as well because that will have a significant effect on reducing the effect of ramping on our hospital system by having more paramedics equipped to deal with issues that will not require transport to hospital. As you can see, there is a vast range of commitments, as other speakers have said as well. I am sure all of us on this side of the house could spend all day talking about all the initiatives that we do have.

There is also an international recruitment campaign which will be targeting up to 700 very highly skilled health workers from across the world. Victoria is already a health destination, already a science destination, for many across our international community. That will continue to be strengthened by the investment in that program with up to $10,000 for healthcare workers coming to work in a metropolitan setting and up to $13,000 for those coming to a regional setting, because it is vital, especially, that we upskill and upgrade our hospitals and our health services in the regions as well.

In conclusion, if I may, this government does have a very strong record on this issue. We will continue to provide the health system that our state needs, and we will continue to provide every support that we can to support our health workers as they do their jobs, which is, as I say, vital to the wellbeing of all Victorians.

Ryan BATCHELOR (Southern Metropolitan) (10:54): I am very pleased to rise and speak on the motion moved by Ms Crozier, which is on the notice paper in her name, seeking under standing order 10.01 the Leader of the Government to bring within 14 calendar days of agreement to the resolution a copy of any and all briefings provided by the Department of Health or any other department, agency or public official to the Minister for Health and/or the Premier from 1 July 2022 concerning staff shortages in the public health system. It is a significant issue, and it is a very wideranging request for the production of documents.

I do want to just reflect a little bit on the contribution that Ms Crozier made in moving the motion and also echo some of the points that my colleagues have already made to the chamber, because they are important. This is a very critical and important issue. The health of our health system relies on the health of the staff who comprise it, because our health system and delivering health care to Victorians are nothing without the people who deliver it, whether they are our nurses or our paramedics, whether they are the orderlies and cleaners who make sure our hospitals are functioning or whether they are the doctors or the surgeons who are performing those sorts of things – you and I could only imagine how difficult and stressful that work is.

We know that the work that is done in our healthcare system by these outstanding health professionals – and I join my colleagues in paying tribute to them – can only be done successfully when supported by a government that believes in the work they do but demonstrates that belief by making sustained and serious investment both in the health infrastructure but also in health services and importantly in healthcare training and workforce development. We know that since coming to government the Andrews Labor government has invested more than $2 billion in the training and development of our health workforce – that is $2 billion more for our nurses, doctors and allied health professionals. That means since 2014 we have seen nearly 4000 more doctors in our health system, a 44 per cent increase; nearly 10,000 more nurses, a 27 per cent increase; and we have more than doubled the Ambulance Victoria workforce, with almost 2000 more paramedics.

But we know that particularly in the course of the last couple of years it has been incredibly difficult to get the scale of training and recruitment through our domestic training pipeline to meet the demands that our healthcare system is seeing, which is also why we have taken the decision to accelerate our international efforts to recruit an additional 2000 international and expatriate healthcare workers. Often these are Australian healthcare workers who have gone overseas, and part of this resource is to try to get them to come home, and we think that is an incredibly important part of making sure that our health workforce is strong.

I want to talk a little bit about the underlying causes and stressors that we are seeing on the workforce particularly in our hospitals but also in other healthcare settings. Of course we have gone through a one-in-100-year pandemic. The impact that pandemic has had on our healthcare workforce is serious and significant. In my previous life in my previous job I did some research on the question of: what were the international trends of the international healthcare workforce? The common themes in that research were things like burnout and exhaustion were real, and what the staff – particularly the nursing staff in our hospitals but right across the board with those allied health professionals and doctors – were telling us was both that they needed to have the support of increased programs and increased services but also that they really appreciated in the institutions in which they worked having their voices heard and having theirs voices listened to, because when they feel like they are being valued and part of the system, they can work and everyone can work together to try and make sure that those institutions that are delivered to patients are working as seamlessly as possible.

One of the things the pandemic did in providing an enormous burden that needed to be addressed in terms of the need for healthcare services was it also opened up the door to innovation and an ability for our healthcare workforce to adapt and respond quickly to the needs that were being presented to it. So I think, in considering the action we are going to be taking and the requests that are being made of the government to deliver information about the healthcare workforce through this request for documents, we do need to consider some of those issues.

But the other point – I think it was well made by my colleague Mr Galea – was that the shortages that we are experiencing today are because of the actions of the past. You do not just turn up one day and find you have got healthcare shortages. You do it because you have had sustained periods of underinvestment in skills development and training at a national level in this country, and that is what we are seeing the consequences of. We did have nine years of a federal coalition government which systematically underfunded and undermined our public healthcare system, and that has had serious issues on the workforce. But unfortunately we did have a period here in Victoria when under the last coalition government there were cuts made to our TAFE and training system, and when you make cuts to the training system you impact on future workforce capacity, because you are simply not training the people who are then going to turn up and do the jobs that we see. You cannot ignore what has happened in the past, particularly on the skills and training side of the equation and in the way that the former Liberal government here really decimated the TAFE and skills sector. It has taken a lot of effort and a lot of work, particularly by the minister sitting in the chamber today, the Minister for Training and Skills, to rebuild that training system.

I also want to reflect just briefly on this documents motion that we have got before us today, because it is a very broad motion and it is seeking a range of documents. I just want to go back and quote this:

… any and all briefings provided by the Department of Health or any other department, agency –

and we have got a number of departments and agencies across the public service –

… to the Minister for Health and/or the Premier …

from the middle of last year. I do not want to just label it as a fishing expedition, but that is what it is. It is a fishing expedition that really is designed to divert the efforts of our tireless public servants away from their critical task and critical work – trying to figure out actually how to solve the healthcare workforce issues in this state, providing policy advice and delivering programs so that we fix the problem that is being identified in the motion here. What we are seeing with this motion for the production of documents is an attempt to divert their efforts and activity away from their central task of doing the policy work and doing the program delivery into going back and going through their files, checking their emails and doing the diligent work of document production, which they will do because they are good public servants. Quite frankly, I would prefer those public servants to be spending their time working on a policy solution to this issue.

If the opposition need help in policy development, particularly on the health workforce, there are probably a number of ways they could go about it rather than just by looking over the shoulder of the government and reading a copy of the work we have already done. There is in fact probably a good way: by getting out and talking to doctors, talking to nurses, talking to professional associations and talking to the TAFE and training system about how we tackle our workforce problems in health care, rather than moving in this chamber wide and expansive motions seeking copies of any and all briefings provided by the health department or any other agency in what is in effect an attempt to copy the homework of the government.

We know our policy development is good in this state, because we have got good public servants and we have got a good set of ministers who, as the last election shows, know what they are doing. What we want to see is the opposition potentially spending a little bit more time on their policy development and less time seeking to divert the attention and efforts of our public service into producing pages and pages and pages of documents.

Jacinta ERMACORA (Western Victoria) (11:04): Acting President Terpstra, I am pleased to see you in that role. I rise today to respond to this documents motion in particular relating to staffing issues in the health system. Like my colleagues, I do not think it is possible to talk about health staffing rates without acknowledging the role of all of our health workers during the height of the pandemic and the level of dedication and commitment of those workers who found themselves in a situation that almost no-one in living memory had ever experienced. Very, very few people alive today remembered the previous pandemic. The health administrators also had to respond by developing brand new systems of response that were urgent and life changing. I want to acknowledge those health workers and say a very big thankyou to those workers for their commitment as well.

This government has a really strong record on supporting health worker staff retention, and that has been particularly exemplified in my own Western Victoria Region and particularly in Warrnambool and south-west Victoria. In Warrnambool, at South West TAFE, it is now possible to study nursing for free. As my colleagues have mentioned, this is not going to be a short-term fix, but it is an action nonetheless. Again, at Deakin University in Warrnambool it is now possible to study nursing for free, and in addition to that there is a public sector sign-on bonus for graduate nurses who come on board in the public sector. These are actions, not investigatory requests. These are actions of a government addressing the challenges that we have faced.

There is also no question that we cannot talk about retention of staff and support of a positive environment for health workers without referring to new health facilities. In Warrnambool this government’s $384 million investment in the stage 2 of the Warrnambool Base Hospital is a beautiful example of supporting staff retention and providing an excellent workplace environment along with improved health care. That improved health care will include additional emergency facilities – a larger emergency department, brand new and state-of-the-art – and also new operating theatres in that facility. As part of that project the new laundry and supply department will be constructed offsite. That is a $50 million project on its own that will service the entire region of south-west Victoria in terms of the hospitals. Casterton, Portland and through to Apollo Bay will be serviced by an automated, brand new state-of-the-art laundry and supply department. This is an example of another intervention that this government is doing rather than just sitting back and counting numbers.

Nurse-to-patient ratios are also a significant contribution to retention of health staff, and that has been another improvement experienced by Warrnambool Base Hospital and the south-west region. There is no better place to exemplify the benefit of that than in public-owned aged care facilities during the pandemic, where health outcomes were comparatively stronger. In addition to nurse-to-patient ratios, $44 million for eight new PET scanners, including one in Warrnambool, is another important action that this government has taken. As the Premier pointed out, having access to a PET scanner close to home makes a massive difference to patients and their families. It means answers and, critically, earlier access to life-saving care. This is all part of ongoing future planning for more diagnostic equipment for sick Victorians and recruiting and training more than 24,000 health workers. This will take time, but it is planned and happening as we speak.

In conclusion, this government is actually addressing health worker staffing by taking actions like having nurse-to-patient ratios, free nursing studies and a sign-on bonus and investing in new facilities like the Warrnambool Base Hospital and PET scanners.

Tom McINTOSH (Eastern Victoria) (11:10): I, like my colleagues, am very happy to stand and talk to this today. I hope for all of us in here – in particular I know it is for those on this side with me – health is a fundamental for us; health care must be available to all. I know for me that is a fundamental belief. For all in our community, if we do not have our health, we have nothing. Much like the other fundamentals – access to jobs, safe housing, education and a sustainable environment and climate – health is absolutely critical to us all.

So I thank Ms Crozier for the motion that has been put forward and acknowledge that over the past two years there has been a huge effort from everybody who has worked in the health area in Victoria, around Australia and indeed around the world. For those I have known personally, whether it be family or friends, I know the stress and the strain that has been put on them and indeed their families as they have worked through what has been an incredibly challenging time. But I think it is very worth noting the work this government has done and has done over a very long time on health, and that is why I talk about a fundamental belief – it being fundamental to our core. My colleague Mr Batchelor talked about the lack of belief or commitment that has occurred over a nine-year period in the federal government, which has led to many of the difficulties, strains and stresses that have been put on health services all around Australia and also here in Victoria. So I agree with the comment that it is on all of us to work together to look for policies that are going to get the best outcomes for everybody who needs the health system and health services.

Whether it is the landmark $270 million nursing and midwifery package that will see 17,000 nurses and midwives recruited and trained or the $3000 retention payments for every worker in our health system, this is a government that works with, not against, our health workforce. That is on top of our $12 billion pandemic repair plan. We will be training or hiring up to 7000 healthcare workers, which is important not only to support the system but obviously to get more people into well-paid work. There will be $59 million to support more than 1125 registered undergraduate students of nursing that will enter the workforce each year over the next two years. There will be $9.8 million to deliver 75 registered undergraduate students of midwifery each year over the next two years; $5.6 million to allow an additional 288 graduate enrolled nurses to hit the ground running in our hospitals with the dedicated support that they need; $4.6 million to help allied health professionals transition into advanced practice roles; $1.5 million to support Aboriginal health students with cadetships, scholarships and training support; and $15.7 million for 400 additional perioperative nurses and to upskill up to 1000 nurses and theatre technicians.

We are also turbocharging our international recruitment efforts to employ an extra 2000 international and expat healthcare workers. As I have already said, this has been an issue not just here in Victoria or Australia but around the world – the demand for well-trained workers – and I believe that we offer the conditions and the pay that people are going to want to come here for. It is the work we are doing, the investment we are making, that will see that happen. Since coming to government we have invested over $2 billion in the training and development of our health workforce; that is more than $2 billion in our nurses, doctors and allied health professionals. Since 2014 we have invested record amounts in our health workforce, which has seen continuing workforce growth in the public system, including nearly 4000 more doctors, a 44 per cent increase, and nearly 10,000 more nurses, a 27 per cent increase, and more than doubled our Ambulance Victoria workforce, with almost 2000 more paramedics – that is a 56 per cent increase. And lucky we did, because what we have had coming at us has required all of that.

Again on the international recruitment campaign, healthcare workers are in extremely high demand right across the world, affecting international recruitment pipelines around the country. Nearly 700 highly skilled and highly sought after internationally based healthcare workers have now touched down and are helping boost our frontline health workers across regional and metro Victoria. These doctors, nurses, midwives and allied health professionals are making a huge difference on the ground.

In the global environment, where healthcare workers are in such high demand, we know there is more to do to support international clinicians to call Victoria home. Our recruitment program provides a more competitive incentive package for applicants, financial supports for health services and a strengthened and targeted central campaign. Clinician payments will cover travel, visa, clinical registration and other relocation costs to enable candidates to successfully transition into their new workplace – Victoria. Payments will be $10,000 per metropolitan recruit and, I am glad to say, $13,000 per regional recruit to encourage workers to live and work in regional or rural Victoria. The financial support we are offering clinicians is comparable to programs in other jurisdictions and countries, such as Western Australia and Canada.

When it comes to retention, not only are we backing our health workforce by attracting more health workers into our world-class health system, we are focused on retaining our valued staff, because we know how important it is to look after their mental and physical wellbeing as they carry out this invaluable work. That is why we are delivering more supports for our frontline workforce, including almost $5 million to expand the nation-leading worker wellbeing centre, expand the nursing and midwifery health programs to provide one-on-one psychological supports for more nurses and midwives and expand the doctors health program to make sure that our doctors, junior doctors and specialists have the support they need. I think it is imperative that we support those that are supporting all of us.

All of this is on top of the $32 million statewide package to provide practical psychosocial support tailored to the needs of each workforce, including the provision of psychologists and counsellors onsite to provide proactive support to workers, additional workplace rest and recovery spaces and programs to better support families. We have also invested a further $353 million in the winter retention and surge payment. We continue to work extremely closely with our health services unions and workforce representatives to make sure we are doing everything we can to support them in this time.

Then we have our election commitments – more support for our nurses and midwives. We have got a $150 million package to properly value those who care for Victoria. For our paramedic practitioners we have got $20 million to establish the paramedic practitioner role with an agreed model of care that can strengthen our ambulance service. In a massive boost to the next generation of paramedics this government will invest $16 million to add another 40 mobile intensive care ambulance paramedics to our ranks. To support our GPs, we will invest $32 million to incentivise doctors to become GPs, offering financial incentives for doctors who enrol in a GP training program. The package to increase the number of GPs will deliver $30,000 top-up payments for first-year trainee GPs, ensuring they do not take a significant pay cut to become a GP. We will also cover the cost of their exams in their first year, investing $10,000 per trainee. As I said earlier, that is unfortunately something we are having to address, but we are. The program will be available for two years, and we will continue to work with the Albanese Labor government to increase the number of rural generalist GP training places so that even more medical students and junior doctors can join this critically important profession.

On the ground we have got $250 million for the Monash Children’s Hospital, $200 million for the Joan Kirner Women’s and Children’s Hospital, $135 million for the Casey Hospital, $162.7 million for the Northern Hospital stage 2 expansion, $55 million for the St George’s aged care facility, $577 million for the Victorian Heart Hospital and $115 million for the Wonthaggi Hospital, which was completed this year.

And when we look to the skyline of Footscray we can see that $1.5 billion is being invested in the hospital there. I think I heard the statistic recently that it has more cranes than any other project in Australia. I know I have not seen so many cranes on one project; it really is incredible, as is the pace that that is going up.

There is $900 million to $1 billion for a new hospital in Melton; $1.1 billion for the Frankston Hospital redevelopment; $541.6 million for the expansion of the Ballarat Base Hospital; and $384.2 million for the Warrnambool Base Hospital. I would also like, before I run out of time, to mention the Wonthaggi Hospital and the West Gippsland Hospital.

Georgie CROZIER (Southern Metropolitan) (11:20): Just in response, at the conclusion of my motion, I urge members to support this. I am hoping the government will provide these briefing documents. It is a simple documents motion, as was highlighted in the other place yesterday in a question to the minister on the cancellation of surgery for cancer patients at Peter MacCallum hospital. Professor Michael Henderson said there will be implications for patients who cannot receive that vital surgery. These are the issues we need to understand. They were cancelled because of a lack of staff. So this is what I am talking about. This is a simple documents motion, and I hope the government will reply within the required time frame.

Motion agreed to.