Tuesday, 9 September 2025

Bills

Drugs, Poisons and Controlled Substances Amendment (Medication Administration in Residential Aged Care) Bill 2025

Second reading

Debate resumed on motion of Harriet Shing:

That the bill be now read a second time.

Georgie CROZIER (Southern Metropolitan) (14:16): I rise to speak to the Drugs, Poisons and Controlled Substances Amendment (Medication Administration in Residential Aged Care) Bill 2025. What the bill does is seek to amend the Drugs, Poisons and Controlled Substances Act 1981 to strengthen medication safety in aged care settings, with the aim of qualified health professionals being responsible for the administration of specific medications.

As we will recall, in 2018 the then Morrison government established the Royal Commission into Aged Care Quality and Safety. That was a very significant body of work that looked into the safety components of aged care settings. It looked at what was in the best interests of residents and really did a significant amount of work to try and improve some of the issues that had occurred in residential aged care settings and had come to light. The royal commission made around 58 recommendations, including on a number of things around safety and quality, and providing support, amongst other things, but also looking at establishing a taskforce and looking at the rights of the older person.

It is a really important area, because as Victorians age and find that they do need the support of aged care facilities, everybody wants those residents to be safe. I know this from personal experience. When I was maintaining my nursing registration I worked in the sector and I saw firsthand some excellent care that was provided, but I also witnessed some care that I thought was very substandard. I can relate to what this bill’s intentions are about in relation to providing safe care to elderly residents and providing medications. I recall that sometimes it took hours and hours to do that medication round and ensure medications were provided at the time they were prescribed to be. Those aspects are really, really important.

I can also say that I have experienced it with my own family in recent years with the excellent care that was provided to my father in his last few months of life and how grateful we were as a family to have that care provided by so many fabulous people. We were really quite fortunate because of my father’s mental capacity and his ability to speak for himself, but many are not in that situation. I am pleased that stakeholders and others who have provided me their feedback are very much advocating on behalf of many of those residents who do not have the same mental capacity and who cannot speak out if they are experiencing pain or some other aspect in relation to their medication.

What this bill does, as I said, is it looks at the administration of medication and asks that only healthcare professionals, whether they are enrolled nurses or other health professionals such as doctors and pharmacists, may administer prescribed drugs such as drugs of dependence, schedule 4, 8 and 9 medications and also other medications that are prescribed, such as antibiotics or analgesics, local anaesthetics and benzodiazepines. Some clinical trial medicines are also included in relation to the scheduling of drugs, and obviously drugs of addiction like pethidine, morphine and oxycodone, which need to be closely monitored and generally are in relation to the administration of these medications. The intent of this bill obviously, which I understand completely, comes off the back of the framework, as I said, from the royal commission in looking at those safety and quality aspects that the Commonwealth had looked at through the royal commission and looking at those aged care standards that have been addressed through the royal commission.

The government has said that the changes will address the risk of harm from current practice, which allows personal care workers to administer some of these high-risk medications, and reduce the demand on the acute health system. The government argues that hospitalisations due to medication issues are more likely to occur without the clinical expertise and oversight that only qualified nurses and other health professionals can provide, and I very much have some sympathy around that argument in relation to how prescribed drugs need to be administered appropriately and on time, as I have mentioned. Of course what we want to see is qualified nurses to be able to do this. The royal commission in its final report did mention this and did take note of where there was incorrect administration. In fact it said:

We also heard about incorrect administration of medicines, and of poor prescribing and dispensing practices. These included overuse of medication in lieu of more suitable treatments, and the prescription of medications that have negative interactions with each other.

…

… We heard numerous instances of inappropriate management of medication regimens. We heard about aged care staff members failing to administer medicines correctly or administering medicines but failing to ensure residents swallow them. We heard of failures to administer medicines at the correct time or in the correct dose, and of residents being administered incorrect medicines.

That is at a national level, and of course we understand that those issues can arise. But they do not arise everywhere, and I think that there are some concerns around the unintended consequences of this bill and how that will apply, and I will come to that.

As I said, some of the stakeholders that did reach out and provide feedback, including Dementia Australia, provided me with information to say that 54 per cent of people living in aged care have dementia and pain management is challenging when they are unable to communicate pain levels effectively. And really, to get on top of that pain you need to be administering that pain analgesic properly and in accordance with how it has been prescribed. Obviously they and many other stakeholders understand the intent of this and are in support of the measures to improve the assessment and treatment of pain and other issues by qualified staff in residential aged care settings for people with dementia. Pain and the effect of medication need to be assessed regularly by nurses and others to ensure that residents are getting that prescribed medication and it is working for them. As I said, it can be very difficult in some of these settings when you are dealing with residents who are very frail and they have got multiple conditions. Sometimes their health conditions are very complex, and the medication and the number of medications need to be monitored carefully.

In saying that, they do have other issues that need to be assessed as well, like wound management and like the ability for nurses to deal with some of those areas around a resident’s ability to communicate, their ability to ambulate, their ability to even express that they have got something going on with them. As I said, pain management and wound management is incredibly important, because invariably some of these residents do have very significant wounds that need to be attended to as well, and that can at times need oversight by a registered nurse. The issue here around some of the concerns that have been raised with me is if you take a registered nurse away from being able to oversight a lot of these other issues because they are not dealing with the medication administration, then will that put a resident at further risk because of their inability to be able to deal with the residents in a holistic manner. As I said, part of the reason for this is because of those findings from the royal commission, but also the government has said that there are a number of unplanned hospital admissions because of the inappropriate use of medicines – and they are not insignificant. I have to acknowledge that they are quite concerning figures. I do not know what the breakdown for Victoria is in terms of those hospitalisations, but nationally those figures are quite high.

Again, I think everybody understands exactly what the government is trying to achieve here to prevent those people from ending up in hospital because of inappropriate use of medication or the wrong administration of any medication that has been provided. What this bill does, therefore, with clause 9 is actually require the provider to ensure that medication is only administered by a registered nurse, an enrolled nurse or other authorised health practitioner who can administer it, and as I have said, either a pharmacist or a doctor can then provide that administration to those residents.

The department in their briefing and the government have said there are a number of exceptions to where this may be applied, and that applies to voluntary assisted dying substances and the self-administration of medications by residents where appropriate and safe, and with the voluntary assisted dying substances obviously the resident is therefore responsible with that. The other component of it is in emergency circumstances or unexpected staff shortages where no appropriately qualified staff are available and delaying medication would place that resident at risk. That is in the instances of bushfires or floods, where clearly there is an issue around either nurses being able to be onsite and attending to their workplace or there is a shortage because other staff are unable to attend. So it is really looking at it in a commonsense approach around those exceptions, which we thoroughly understand.

The government has said these exceptions are not intended, however, to apply to rosters with insufficient numbers of nurses but are for those unplanned and temporary shortages, as I have described. The penalties if a provider does not adhere to that are pretty steep. It is 600 penalty units for a registered provider with noncompliance, which equates to around $122,000, and that is going to put a lot of pressure on many providers given the workforce shortages that we have now. Many providers are really struggling, especially in regional Victoria, where they cannot have a never-ending agency supply of staff. It just does not work like that in regional areas like it does in metropolitan Melbourne. For instance, when I worked in this area, as I said, I was agency staff, where they would call me up and ask me to go to various places. That does not occur in regional Victoria, so there is real concern around those providers – and they are very much a part of their local communities – and how those workforce issues will be addressed. I will be asking more about that in committee. At the briefing that we were provided by government, when we queried around these pretty steep penalties that are in the legislation, I was told that educational steps will be in place before penalties are imposed.

That is okay, but it does not take away from the issue if you have got a chronic staff shortage. Your staff are there, and they know those residents and they know the routines in some of these areas. Again, I worked in this area when I worked in my hometown of Casterton in a hospital setting where we had some elderly residents who were in that acute setting as part of their aged care component. You do get to know those residents, and I see Ms Bath is nodding because she understands this coming from a regional community very well. That is the problem, or some of the unintended consequences that I think this bill has, which I have got real concerns with, and I will go to my amendment to that.

Talking about the workforce capacity, it has been reported that the government expects the sector will need to hire around about 650 new nurses to meet the legislative requirements for this legislation. This comes into place next July – 1 July 2026 – and the government has provided a 90-day grace period until 29 September 2026, when no enforcement will be pursued. But there is concern around that. That is 12 months away. It is not that far away. Providers are very, very concerned about how they are going to gear up and how they are going to get that workforce in place to be able to comply with this legislation without being whacked with that huge penalty of $122,000 or that constant threat of how they are going to be able to operate.

We know that there are shortages of nurses across the state. We know that now. We know there are workforce shortages that are really impacting some regional areas, in particular their ability to provide care. The last thing you want to do is to close beds because you cannot meet the government’s own requirements. What then happens to those residents in those local communities? They are then forced back into the acute system or they are placed in residential aged care settings out of their local community, away from their families. That is not a good quality-of-life proposition. That will shorten their life, especially for some who are having tremendous care provided to them. I think that is something that needs to be looked at more closely than perhaps it has. If you cannot get this right in the next year, there is just going to be a lack of confidence in the sector to be able to provide the care that they are. They do not want their residents to be harmed in any way. They want that supported. They understand the government’s intent on this, but they do want a bit of a commonsense approach, and they do need to have that support.

I note that the minister’s second-reading speech noted there was $7.6 million over four years in the 2025–26 budget to support the state-funded services with implementation of this legislation. But there is nothing for private sector providers – the public sector services represent only 9 per cent of the market – so 91 per cent of the market where this is going to apply. Admittedly, not all are in regional Victoria, where I think the workforce shortages are more notable, but that is still a significant amount. There is nothing in there for private providers for the implementation.

There are a range of issues that I have raised: those workforce shortages with the inflexible requirements that will worsen the existing workforce shortages, making it difficult for aged care providers to comply, and the impact on clinical care and the issue around registered nurses being able to assess and assist with that wound care. It is not only that; it is the triaging and the support and it is when palliative care is required – the very, very necessary and important part of palliative care provides that support for those high-care residents at that time, at the end of their lives. The concern is giving these additional medication duties to others and taking them away from some who have them now may have a negative impact on the ability to provide essential clinical care to residents in these settings.

The other area of concern that has been raised is the risk of burnout and attrition because of the increased workload that this might impose if providers cannot adhere to what needs to be undertaken and there is more pressure put on nurses. Again, I have already mentioned potential bed closures, but that I think is a very alarming issue given our ageing and increasing population, where the demand is going to be greater, not less. If you have got providers not being able to assist in giving that care to residents at the time of the end of their lives and in giving support to the families, then that is one of those unintended consequences that I have mentioned. Delaying any care delivery, whether it is wound management, whether it is supporting palliative care or whether it is the administration of timely medications, will impact a resident’s quality of care.

This bill is around quality of care. It is around the administration of medication in a safe manner. I fully understand that and I fully support that intent. What I do want to point out though are the concerns raised by a number of stakeholders, which I will question the minister about during the committee stage. But it is why there are those issues around the review, which the government is proposing to occur in 2031, so that is five years from next year. It is too long. It is just too long. I am just wondering if I could have my amendment circulated, please. The amendment is a very simple one: it is really to try and provide the guidance and support to aged care providers to have that review in two years from next year – that is in 2028, so virtually three years from now – so that providers can plan and they can understand what is going on. They already have a lot of data around workforce, and they are saying that they just do not have the workforce capacity. Five years is too long to have that review. We should be working on that now. We should be understanding some of the issues now, working towards that, to assist with what the government is wanting to achieve here by providing that quality of care that the bill intends to do and not have those unintended consequences, as I have pointed out.

I would hope that members of the crossbench agree, and I have spoken to them. I know that Mr Ettershank, who has worked in this area for something like 20 years I think he told me, understands exactly the intent of what the government is doing. I do not want to verbal him, so I will let him provide his contribution, but I am of the understanding that there are a number of crossbench members that think the five-year review is too long. I would have been very happy to work with government on this. I was speaking to the minister’s staff last week and looking at whether we could come to some agreement about this review so that we can get it right. I understand that that is not to be. I understand that that is not the case. The government will not agree to a two-year review – or I would be happy to go to three years – but five years is too long. I think that for those crossbench members – especially the Greens, who represent areas where they are going to be impacted the most – it is imperative that they support having that review in a timely manner and do not push it out till 2031. That is just too long. It is 2025 now; that is six years away. We know we have got a workforce shortage issue. We know there are issues in the system, but having a review in 2031 is too far down the track, when so many providers need that clarity and need that support now.

As I said at the outset, whilst the Liberals and Nationals absolutely support the intent of this bill, I would hope that we could get a sensible compromise in the review process so that providers, whether public or private, can have the assurance that they are doing what is intended by this legislation: that nurses are there to provide that support and, importantly, that the workforce is there that can provide not only medication administration but those other things like wound care, palliative care, triaging and supporting staff and the family members of those residents. As I said, I have seen firsthand some excellent care provided, and I do agree that we should be doing everything we can to provide excellence in care to protect elderly residents. Too often the horror stories have come out, but we have come a long way. The royal commission really did do a deep dive into that and did do some excellent work to provide assurances to the Australian community – and to all of us as we are dealing with this issue – that those elderly residents are given the care and the dignity they require if they do need to access and be supported and cared for in residential aged care services.

Again, I say that I will have some questions for the minister. I do thank the minister’s office for providing the information and answering a number of questions that I have had, but we will seek some clarification in the committee stage.

Sonja TERPSTRA (North-Eastern Metropolitan) (14:42): I rise to make a contribution on the Drugs, Poisons and Controlled Substances Amendment (Medication Administration in Residential Aged Care) Bill 2025. This is an important bill that makes some really important changes. Notably, these amendments come about as a consequence of the 2021 Royal Commission into Aged Care Quality and Safety.

Just before I came to this place I was privileged and fortunate enough to work for the Australian Nursing and Midwifery Federation Victorian branch, one of the biggest unions in this country. I am not a nurse. I was a lawyer and I was there to do industrial work, but I was very fortunate to learn all about all things nursing because I had some fantastic dedicated nurses in my team who I had responsibility for. I was really impressed by the depth of knowledge, the skill, the care and just the detailed knowledge and information and depth of that that nurses have in caring for people. I commend Ms Crozier for her contribution in this space; I know Ms Crozier’s background as a nurse and healthcare worker.

What we are seeing in our healthcare system is that older people are increasingly entering residential aged care later in life and often with much more complex health conditions that cannot necessarily be managed safely in their own homes. The complexity is increasing and when that happens, you need really skilled, competent and qualified staff. One of the things that the royal commission noted was that there is a tiered approach to staffing. You have nurses, you might have enrolled nurses, but then you have also got personal care workers. What was noted in the royal commission was the importance of having skilled and qualified trained nurses being able to administer medications to reduce the risk of mistakes, or perhaps if you were administering medication and you were not there to monitor it, particularly when you are dealing with a resident who may have complex care needs, you need to make sure that the resident has actually consumed the medication that they have been given. If that does not happen, then the complexity of care that that resident may be facing can change. Things can get more complicated, and they can get very unwell pretty quickly.

Managing complex cases in that environment often requires people to take multiple medications, and that can increase the risk of medicine-related problems, and often the requirement for someone to monitor that patient or the resident more consistently and more intently would arise. It is interesting to note that the Commonwealth data that covers the period from July to September 2024 noted that 36 per cent of people living in Victorian residential aged care facilities – this kind of shocked me when I read it – are prescribed nine or more medications, which is the highest rate of polypharmacy in the country. Ninety per cent receive antipsychotics, which carry a particular risk if not managed appropriately. Obviously antipsychotic medication is one medication that is used to manage patients who may have dementia.

As I said, I learned and I reflect back on the team members I had in my team, and I remember having a nurse who was experienced and trained in what they used to call ‘psych-geri’, which is psychiatric-geriatric, and I learned about the complexity of care that is required in managing an elderly patient who is experiencing dementia. I was fortunate enough, as I mentioned in my members statement earlier today, to visit Vasey RSL Care at Bundoora, and we visited the memory unit and were able to visit with patients who were experiencing dementia. I saw the settings that they were being cared for in, but I also noted the ratio of staff to residents, and the constant level of care that was provided to those patients I was really impressed with. You could just see the complexity of care that nurses were being presented with. This is why it is incredibly important. When you look at the number of medications that are being prescribed, the need to monitor consistently residents who are receiving either antipsychotics or other medications – you can see why that complexity would increase and of course the interactions of any other medications that might be experienced by patients.

This is why the 2021 royal commission into aged care noted that this was an essential area for improvement, and the royal commission’s report highlighted the incidence of inappropriate management of medications, including medicines not being administered correctly or residents being given tablets without oversight to ensure they swallow them. As I said, you have got to make sure they get swallowed. While medication harm can occur at different points of the process of using medicines, including prescribing, dispensing and administration, the Victorian government is responsible as to who can administer the medication in residential aged care, and that forms the basis of the amendments to the act that we are proposing today. Effectively, what the bill will do is place an obligation on Victorian residential aged care providers to ensure that only registered and enrolled nurses administer prescribed and dispensed drugs of dependence, including schedules 4, 8 and 9 medications – they are medications that are listed in the schedules.

It will also provide that regulations may prescribe circumstances where the obligation does not apply – so of course there may be some exemptions provided for in regulation – and how these circumstances should be managed. The bill will also modernise language and terminology, including to align with the Commonwealth government’s new Aged Care Act 2024. It is proposed that these obligations would commence from 1 July 2026 and would give industry providers nearly 12 months notice to make any workforce changes if they are required. Obviously they need to make sure their workforce is informed and trained and able to manage these changes, but also, consistent with the Drugs, Poisons and Controlled Substances Act 1981, the obligation will carry criminal penalties of 100 penalty units for noncompliance. Again, what this is all aimed at doing is driving down the potential for any mistakes or errors or non-consumption of medication, because obviously what the royal commission found was that in this particular area there was room for improvement and more effective management of patients with complex care needs. So again, the obligation will only apply to residents who do not administer their own medication and only while they are at a residential aged care home.

The bill will not remove a person’s right to administer their own medication if it is safe and they wish to do so. Again, these changes are not overriding anyone’s agency or ability to administer their own medication if they have the capacity to do so. It will also not impact other registered health practitioners such as GPs, dentists, pharmacists and paramedic practitioners administering medication as and when deemed necessary, and it will have no impact on the voluntary assisted dying framework. It will also not impact Aboriginal and Torres Strait Islander health practitioners and Aboriginal and Torres Strait Islander healthcare workers.

Importantly, even though the royal commission did happen some years ago, in regard to these particular changes the Department of Health has consulted thoroughly on this reform. These changes also build on the initial consultation from 2022. More recently the department has been working with unions, peak bodies, the Commonwealth government, industry experts and providers to design how the reform will be implemented, ensuring it maintains its robustness while being practical and contributing to improvements in the quality of care for older people living in Victoria’s residential aged care homes. These reforms are targeted. As I said, they have come about as a direct consequence of the royal commission, which noted that these reforms were necessary.

In terms of support for the sector, whilst some providers may need to make workforce changes to comply with the requirements and recruit additional nurses, most residential aged care homes have nurses administering medications already, so some providers may find there is no need for them to make any changes. Nevertheless, on average, based on a 2024 survey, nurses administer medications 91.2 per cent of the time in government-run facilities and 81.2 per cent of the time in non-government homes. As mentioned, the commencement date of July 2026 will give the sector around 12 months to prepare and be ready to implement any changes if they are required to. This is in addition to the 90-day grace period that means no enforcement action will be taken on any provider until 29 September 2026. All of these measures have been done in consultation with the sector. The government has listened to the sector in terms of the proposed timelines that it has said that it would need and which may be necessary in order to accommodate these changes, and the changes are a direct result of that consultation process.

Also, the new Aged Care Act has financial reforms that are expected to increase the financial sustainability of the sector, which is also critically important. There is work already occurring under Commonwealth reforms that mean that reforms can be delivered without significant investment from the sector. This is direct support for the sector, and this includes workforce adjustments; funding model reforms, which will provide greater funding certainty and allow for more adequate staffing levels; and also minimum care minutes, which include 44 minutes of direct care by a registered nurse. Those care minutes are directly tied to funding, and that gives certainty to the sector. Again, we see more Commonwealth funding flowing to ensure that the appropriate level of care can be given to elderly patients – this locks that in, it bakes it in, at a more appropriate level.

Other Commonwealth reforms, including the decision to fund the Fair Work Commission’s pay increase, will likely continue to contribute to improved supply across government and non-government sectors. It is critically important that our nurses and people who work in the aged care sector are appropriately remunerated. We need more people to work in aged care as more and more Australians require aged care support. As I said at the beginning of this contribution, more and more people are going to be needing support as they age, but we are seeing more complex care needs that are being presented when people are coming into aged care, so we definitely need a more skilled and experienced workforce who are able to manage these complex care needs.

In March 2025 Ageing Australia CEO Tom Symondson said:

We’re hearing reports from across the sector that it’s becoming easier to attract and keep aged care workers …

and that really is good and welcome news. He also said:

[QUOTE AWAITING VERIFICATION]

I can mention other supports proposed, including the model of care in-person forum that will bring together government and non-government providers to exchange best practice and improve quality and potential efficiencies in the medication process.

It is good to see there is a commitment from the sector to see a continuous improvement model coming forward, because again, wherever the sector can work together to ensure we bring down any unintended consequences from medications – whether it is from people not consuming it properly or mistakes and the like – any of those things are going to be welcomed, particularly when they improve the quality of care for elderly patients. Again, there is a voluntary insight survey that will also provide an overview of how this reform is being implemented. So it is good news when you see the sector working together to make sure that patient outcomes are improved.

In addition to this, the Victorian government has ongoing initiatives, incentives and policies to support and increase the nursing workforce, including in aged care. Before I came to this place, as I said, I was working at the nurses union, and there was constant discussion about how we could improve the pipeline of nurses coming through. One of the things that this government has done is make the diploma of nursing available under the Victorian government’s free TAFE initiative, which we hope will increase the pipeline for additional enrolled nurses for government and non-government health and care sectors. That was one initiative that the government took. We also have the making it free to study nursing initiative, aiming to increase the public sector nursing workforce, including in public sector residential aged care services. You can see also the 28.4 per cent increase over four years to nurses and midwives in the enterprise agreement 2024 to 2028.

The clock is going to beat me. There is much more I could say about this, but I know other people in the chamber also wish to make contributions on this. I will conclude my contribution there and commend this bill to the house.

Melina BATH (Eastern Victoria) (14:57): I am pleased to rise to make a short contribution on the Drugs, Poisons and Controlled Substances Amendment (Medication Administration in Residential Care) Bill 2025. In doing so I would like to put on record that the Nationals and the Liberals are not opposing this bill. We do have a very sensible amendment put forward by my colleague and lead speaker Ms Crozier in relation to a two-year review rather than a five-year review of this particular initiative. In doing so I would also like to begin my contribution by thanking all the wonderful staff that work in our aged care facilities right across Victoria, but in particular in my Eastern Victoria electorate. It is a very special place that people choose to work in – an aged care facility. As a family member of relatives who have entered into the aged care sector, really we often know that they are regularly in the last stages of their life and that we really want them to be treated with the utmost care and compassion. The aged care facility becomes an extension of a home-like environment in which family members who cannot, for various reasons, be with a loved one 24 hours a day know that that loved one – that friend, that relative – can get the very best care to support them in their twilight years.

Some of that care of course comes from personal care workers. Certainly I know my former father-in-law, as I call him still, was in metropolitan Melbourne, and one of his personal care workers encouraged him to sing. He was a singer, and they would sing duets together. This enlivened his day; revived the beautiful music that he experienced throughout his life, which he could sing so beautifully; and provided much entertainment and merriment for the other participants and aged care residents. I also know in my own home town family members have gone to Woorayl Lodge in Leongatha, and I know of the very important work done by not only the personal carers but the staff and the management, who are so very important; the enrolled and registered nurses; of course the doctors that come through and support the residents; and the cleaners, the diversional therapists, the kitchen staff and the maintenance staff.

It all tends to become, when it is working well – and I underline that, when it is working well – a greater sense of family. I also know that many, many volunteers in the community, whether it be on boards, really embrace their towns’ aged care facility – or multiple if you are a larger centre – because it is such a valued entity in our lives and in our communities. So I am putting on record my thanks for those. Indeed there are many volunteers who fundraise for extras and provide that support and donate and create that family environment. One particular lady I would like to single out is a lady by the name of Lorraine Bartling. Lorraine is now well into her 90s, and she has devoted her life. She instigated and was one of the founding members of Yallambee village in Traralgon and then Margery Cole in the 1960s. She has been a nurse and has actually worked in these facilities as well as in hospital settings. She has also been the Traralgon city mayor, a trailblazer in her time. I saw her at a combined dinner for the emergency services and defence force only a few Saturday nights ago, and she herself has formerly said to me she has stood down from – get this – issuing and being present for aged care people in those centres doing palliative care. So she has had her whole life in service to her community. Whilst I single her out for our great thanks, I also want to put on record that there are many other shining examples of these wonderful people, male and female, who devote their extra time, maybe their retired time now, in the service of their communities in aged care facilities.

In relation to the bill, we will not be opposing the bill, and we certainly recognise the intent to improve the medication safety in aged care facilities and bring Victoria into line with other aged care standards from the Commonwealth reforms. I know my colleague Ms Crozier spoke about the royal commission some years ago. The issue that we have very regularly in regional Victoria of course is workforce shortages. You can call them thin markets, you can call them a rostering headache for administration. It is these situations that many aged cares in regional Victoria have to accommodate and cope with. I guess that is one of our concerns or flags for the government when there will be penalties of up to $120,000. If after the time of, we will say, consideration of and adaptation to this legislation, if people end up breaking the law, as it will be in the legislation, then there could be some hefty penalties. I am putting forward my concern about those thin markets in regional Victoria and in my electorate.

In terms of what this bill actually does, it amends the Drugs, Poisons and Controlled Substances Act 1981 and ensures that only qualified health professionals, registered nurses and enrolled nurses with medication accreditation or doctors or pharmacists can administer schedule 4, 8 and 9 medications, which include opioids. There are some fairly strong drugs in here: benzodiazepines, antibiotics, anaesthetics and other clinical drugs. So those personal care attendants that do exist in our centres are no longer able to administer these high-risk medicines. Of course we have heard that there is a section in this legislation that says residents that are still able and capable of providing their own self-administration can continue to do so. There is also a section that says that if there is an emergency or unplanned staff shortage, someone may be able to administer if a delay in giving that medication while waiting for a registered nurse or an enrolled nurse to come in would then endanger the life of the resident.

We know the bill does not interfere with assisted dying practices, which were brought in some years ago. It brings Victoria into line with laws from other parts of the nation. What is quite concerning, and we have heard it in other contributions in the house today, is the amount of medications that some aged care residents can be on. Thirty-six per cent of Victorian aged care residents are on nine or more medications, and 19 per cent are on antipsychotics, making clinical oversight, clinical understanding and measurement and review of medications very, very important.

Many years ago, when I was a wee girl, I ran a health food shop – Leongatha and District Health Foods; it was very exotically named. We offered vitamin C and all sorts of things, but I regularly asked people, if they were considering taking some form of vitamin supplement or herbs, to make sure that there were no contraindications with any medication that they were taking. It is these interactions, these contraindications, that play a key role in the formulation of this legislation in a national setting but drilling down.

I sometimes am quite alarmed. I heard from a constituent recently that one of my constituents was hospitalised because they were on multiple, multiple, multiple medications. They were not in aged care, but the multiple medications were being prescribed by a doctor. This happens – this is not an isolated case. The interactions between that layering of those medications created a most unwell status. I put on record that our medical profession, our doctors, need to be across these sorts of medications.

We do value very much our nurses, both enrolled and registered. I have said this before in the past. I have two children, and one of my sons is a nurse. I am very proud to be the parent of a qualified nurse who is doing great things, unfortunately in a different state. One other thing I would like to raise in relation to this is that element of dementia. The work that Dementia Australia does is very important; I think it is a federally funded organisation. It seems like there is an almost evolving prevalence of both Alzheimer’s and dementia.

Going back to the very important work that nurses do in assessing and administering medications in all sorts of settings, the Pharmaceutical Society of Australia estimated that 20 per cent of unplanned hospital admissions from aged care facilities were a result of inappropriate uses of medication. That is where that holistic look needs to be attended to, both the doctors prescribing the medication in the first place and then the administration.

I go to a point that my colleague Ms Crozier raised in her debate in relation to this legislation and accommodating this legislation. It is all well and good to bring legislation into the Parliament with good advice, but it is also around how that is managed. Victoria will need an additional 650 nurses statewide. I know my colleague Mr Tim Bull, member for Gippsland East, across his brief also made comments in relation to the need in our community, particularly in his community, which is also in mine in Eastern Victoria, in East Gippsland and the concern that he has in relation to meeting those needs. One of the key phrases in this legislation is ‘must ensure’ that a qualified person administers the medication after this time period. Sometimes that is going to be very, very challenging for aged care settings in the region. I know the bill allows for these unplanned shortages, but what about those thin rosters that continue to be taken on? In conclusion, again I endorse the Liberals–Nationals amendment, which looks at narrowing that review back from five years, which is a long way out into the future – once this begins it is 2031 – and reduces that down so that there is some consideration, there is analysis, there is review to see if there are any issues that are going to emerge from this. So I endorse, certainly, our amendment to bring that down to two years.

In conclusion, I again want to put on record that this is often a vulnerable and tender age that people in aged care facilities exist in. It can be the very best of times, when families can feel very comforted by the great care that is given, but what we do not want to see is two things: (1) of course those hospital administrations by mixed medications not reacting well, and (2) we want to see that this can be achieved by all of our aged care facilities, particularly, in my case, in regional Victoria, so that this can work, so that these centres can deliver very high care and so that families can go to sleep at night knowing that their loved one is looked after and is well in their twilight years.

Jacinta ERMACORA (Western Victoria) (15:12): I am pleased to speak on the Drugs, Poisons and Controlled Substances Amendment (Medication Administration in Residential Aged Care) Bill 2025 – that took 15 seconds. This bill will ensure that in residential aged care medicines are administered by health professionals who are trained, registered and accountable.

The issue of safety for elderly people is one that all Victorians would feel strongly about. In the south-west of Victoria it is an even more pressing issue. We have a higher proportion of older people in all age brackets above 65 than Melbourne, and that is where I am going to focus some of my contribution today. By proportion of population, we have 30 per cent more people aged between 80 and 84 and 40 per cent more aged over 85. We also have equal or higher needs for complex health care. The Australian Institute of Health and Welfare reports that rural areas have higher rates of arthritis, asthma and COPD, which require ongoing expert treatment.

As is the case across Victoria, our elderly people are entering aged care later in life. The national median age for people moving into permanent residential aged care is now 85. Almost three in five residents are over the age of 85. At the same time, many older people are supported at home for longer. That means that when people finally do enter residential care, they are older and frailer and their care is more complex.

As my colleague Ms Terpstra mentioned a few moments ago, more than one-third of Victorian aged care residents are prescribed nine or more medicines, and this is the highest rate in the country. About 19 per cent are given antipsychotic medication, and these drugs need some very, very careful oversight. For too long in some homes unregulated personal care workers have been placed in an unfair position of administering powerful medicines. These are dedicated people, but they are not registered or trained as nurses, and they should not carry this responsibility. In consultations on the bill, the Australian Nursing and Midwifery Federation was clear that in the past residents were sometimes given medicines unsafely as a result. The Pharmaceutical Society of Australia has estimated that one in five unplanned hospital admissions from aged care is linked to inappropriate use of medicine. In small towns, when a medicine error leads to deterioration, the only option is often an ambulance ride to a larger centre and a hospital admission far away from family. Getting medicines right the first time is a lifeline that prevents avoidable transfers and trauma for families and patients alike.

This bill strengthens our approach to reducing these risks. It amends the Drugs, Poisons and Controlled Substances Act 1981 so that only qualified professionals can give the highest risk medicines in residential aged care. This includes registered nurses, appropriately qualified enrolled nurses and authorised health professionals such as GPs and pharmacists. It allows residents to continue to give their own medicines if it is safe for them to do so, and we have certainly had that mentioned by Ms Bath and also by Ms Terpstra. It is really important that a piece of legislation like this does not sweep up and capture inappropriate situations. It does not change the arrangements in hospitals, in the home or under the voluntary assisted dying scheme. I think that is very important too – they have got their own set of rules and obligations in those spaces.

This bill is practical. Regulations will set out what to do in exceptional circumstances, such as when a qualified professional is not available and a delay in medication would put a resident at risk. This will not be a get-out clause for understaffing. It reflects the reality of busy residential care homes where there may be a sudden patient emergency or, as we know, every now and again a whole community in a small town can catch the same bug going around – both staff and residents – which can lead to a situation with understaffing. In smaller rural care homes that may rely on a smaller number of staff, it may also be required when a staff member is unexpectedly unavailable.

This government recognises that it may take time for services to prepare for these changes, and we have set a start date of 1 July 2026, with a further 90-day grace period for organisations to get their act together from a practice perspective and get their policies and procedures reflected in their practice on a daily basis. Compliance will focus on real risks, not on the technicalities. There will be communication with the sector, opportunities to share best practice and a five-year review to make sure the reform is working.

Public sector residential aged care services form the overwhelming majority of rural residential care services. Recognising the particular challenges they face, we have allocated $7.6 million in support in the 2025–26 budget to help them to implement these reforms. Whilst these reforms are applicable to every aged care service provider, the state government is supporting its own state-run facilities to implement these changes. This is not a reform designed in isolation. The government consulted widely in 2022 and again in 2024. Providers across the public, private and community sectors, unions and peak bodies took part. The bill reflects what many good homes already do, and it helps the rest of the sector get there.

Nurses are strongly behind this reform. Australian Nursing and Midwifery Federation Victorian branch secretary Maddy Harradence said in support of the bill, on 4 August:

Medication administration is a core nursing responsibility and these changes support nurses to work to their full scope – delivering safe, high-quality, person-centred care and improving job satisfaction.

As in the whole of the country, qualified healthcare workers are in high demand across regional Victoria. Thousands of additional nurses are needed across the state in coming years, and that is why this bill is matched with strong workforce support. This government is providing 10,000 free university places for nurses, and we have made the diploma of nursing free at TAFE. Student nurses can work in clearly defined and appropriate roles while they study. To encourage more people into the profession, nurses and midwives are receiving a 28.4 per cent pay rise over the four years under the new enterprise agreement. There is also $95.1 million over four years to support the health workforce, including rural nursing, graduate programs and skills development. As the Minister for Ageing has said:

These changes are about putting the safety of residents first – making sure our older Victorians … receive the right medication, safely and at the right time, from the right professionals.

That is what families expect, and it is what older Victorians deserve. In small rural facilities this reform will save residents from avoidable decline and hospitalisation. A nurse on a medication round can assess, decide and act if something is wrong. The nursing federation has said the changes will reduce clinical risk and cut down hospital transfers caused by medication errors. That will relieve pressure on regional emergency departments and keep older people closer to home. It also meets community expectations. The Minister for Health has said:

These reforms will ensure that medication in aged care is handled with the same care and clinical oversight you would expect in any hospital …

In country areas, where the aged care home is often part of the local health service, that consistency will strengthen the already existing trust.

This bill also fits the national reforms. The Commonwealth has introduced mandatory care minutes and new funding models. Victoria is the only state to make it law that only registered health professionals can give schedule 4, 8 and 9 medicines in aged care. I do point out that this is another example of national leadership from the state of Victoria. Let us remember what this means for families in Western Victoria, my electorate. Residents in our towns often live with several chronic conditions at once. They may be taking a dozen medications with complex interactions. One missed antibiotic dose or one sedative given without the right clinical judgement can turn a manageable problem into a hospital transfer hours down the highway. This reform reduces that risk at the source.

It also supports our healthcare workers. I must say it is a very, very stressful experience to be in any workplace where you are asked to do something that you are not qualified to do or not skilled to do. This reform provides a clear framework and expectation for staff that is supportive of staff. And if you flip it the other way, it is also stressful as a staff team member to observe unsafe practices without any recourse to actually require those practices to be fixed. So I think it is no surprise that this bill is supported by the people who are going to be implementing it, which is the nurses. It says to personal care workers: your work is essential, but you should not be asked to do what you are not trained or registered to do. And it says to nurses: we value your skills, and we will support you with laws, pay, training and staffing that respect your skills and your role.

Most of us will one day care for or be an older Victorian, if we are lucky, who needs help and medicines. Victorian families are entitled to be confident that the right person with the right training is giving the medicine at the right time. This bill makes that possible. It reflects the best of Victorian health care. It is evidence based, centred on the patient and fair and supportive to the workforce, and it is backed with the funding and workforce planning needed to succeed in every community, especially in rural and regional Victoria, and I commend the bill to the house.

Ryan BATCHELOR (Southern Metropolitan) (15:27): I am pleased to rise to speak on the Drugs, Poisons and Controlled Substances Amendment (Medication Administration in Residential Aged Care) Bill 2025 in the context of health and health care being a fundamental priority of this Labor government. We fund health care; we support our healthcare system and our healthcare workers to make sure that healthcare in this state is accessible, and because we think it is so important to have a strong, accessible and well-funded healthcare system this government has made record investments in Victoria’s healthcare system since being elected in 2014, because quality health care should not be a choice but one of the many pillars that support all Victorians. That is why we have continued to invest in health care here in Victoria.

Recently we saw that the community pharmacy program has been such a success that we have made it permanent and expanded its scope so that more conditions can be treated by pharmacists, saving people time and money. We have invested in our paramedic practitioners, an Australian first, allowing practitioners to deliver high care to patients when they need it. We have invested in virtual women’s health clinics, providing free expert medical advice and treatments for a range of women’s health needs right across the state. All of these investments provide one thing, accessibility – accessibility to our healthcare system, accessibility to medicines and accessibility to quality healthcare workers, because we understand that different parts of the community require different healthcare needs.

Older people, as they enter the residential aged care system, often do so with more complex health conditions and medications, and with that complexity comes requirements, often for protections and making sure that they have accessible professionals that can meet their unique needs. Supporting that system is at the core of this legislation that we are debating here today. The bill increases the clinical capacity of our healthcare workforce so that only those with the education and clinical training – nurses and registered health practitioners – can administer drugs of dependence and schedules 4, 8 and 9 medications to people living in residential aged care. The bill improves accessibility to healthcare workers, giving older people living in aged care increased access to their registered medical professional. It improves the accessibility to receive safe medicines so that people living in aged care can be administered their complex medications safely and accurately, and it improves our healthcare system by reducing the amount of unplanned hospital admissions from residential aged care as a result of inappropriate medicine use, and this all results in improved health outcomes for people living in aged care.

We know that as people enter aged care, older Australians have more complex health conditions. Obviously depending on the advice of their treating doctor they are often are required to take multiple medications and the risk of medicine-related problems increases. Based on Commonwealth data from the period July to September 2024, 36 per cent of people living in Victorian residential aged care facilities are prescribed nine or more medications, which is the highest rate of polypharmacy in the country, and 19 per cent receive antipsychotics, which can carry particular risk if not managed appropriately. As the number of medicines people take increases and the complexity of their care needs increases, the risk of medicine-related problems also increases. In 2020 the Pharmaceutical Society of Australia estimated that 20 per cent of unplanned hospital admissions from residential aged care are the result of inappropriate medicine use. In 2021 the Royal Commission into Aged Care Quality and Safety identified medication management and safety in residential aged care as an essential area for improvement. The royal commission’s report highlighted inappropriate management of medications, including medicines not being administered correctly or residents being given tablets without oversight to ensure that they actually swallowed them. While medication harm can occur at different points in the process of using medicines, including prescribing, dispensing and administration, the Victorian government is responsible as to who can administer the medication in residential aged care.

This legislative reform has its genesis in 2018, when the Victorian government undertook a review of how medication was administered in residential aged care settings. That review found gaps between best practice and what was actually occurring and recommended that legislative change be made to improve practices involving medication. A subsequent sectorwide consultation was undertaken in 2022, exploring opportunities to strengthen medication management and administration in Victorian residential aged care. Consultation included unions, aged care providers, personal care workers and people with lived experience.

The aged care royal commission’s report also found that the routine care of older people in residential aged care often did not meet expectations, and as such mandatory care minutes were introduced so that older people in aged care would receive specified and dedicated care time as required. Since October 2023 healthcare providers have increased their staff numbers and are now including 44 minutes of direct care by a registered nurse to their residents. Commonwealth reforms have given certainty and improved funding to providers so that more appropriate care for the needs of residents are met. This change has allowed for adequate staffing levels to provide quality care for residents.

This bill helps ensure that older Victorians receive the best and highly skilled care from our registered and enrolled nurses in residential aged care. The bill, on its terms, seeks to avoid medicine-related problems for people living in residential aged care through amendments to the Drugs, Poisons and Controlled Substances Act that will place an obligation on Victorian residential aged care providers to ensure that only registered and enrolled nurses administer, prescribe and dispense drugs of dependence and schedule 4, 8 and 9 medications; provide that regulations may prescribe circumstances where the obligation does not apply – exemptions, for want of another term – and how these circumstances should be managed; and modernise language and terminology, including to align with the new Commonwealth government’s Aged Care Act 2024. These obligations are proposed to commence on 1 July 2026, giving providers nearly 12 months notice to make the workforce changes if they are required. In keeping with the provisions of the drugs and poisons act, the obligations will carry penalties of 100 penalty units for noncompliance.

I think it is important in the context of a debate like this, and particularly when we are outlining what the bill is going to do, to just clarify what it is not going to do. The bill is not removing any person’s right to administer their own medication if it is safe and they wish to do so. The bill will also not change how medication is administered in other settings, such as in someone’s own home or in hospitals; it only applies to the residential aged care sector. The bill will also not change how the voluntary assisted dying scheme operates. It will not impact on how other registered health practitioners, such as GPs, dentists, pharmacists and paramedic practitioners, administer medication, and it will not impact on Aboriginal and Torres Strait Islander health practitioners and Aboriginal Torres Strait Islander health workers.

The Department of Health has consulted widely on this legislation. It has consulted with almost a third of the non-government sector involved in the area, such as charity and community, religious and culturally and linguistically diverse providers in both regional and metro locations. Most recently, the department engaged the sector on this reform for its implementation, both in the development and the implementation plan for this legislation, so that it remains strong and protects people while balancing practicality and ease of implementation. This will ensure the bill continues to improve the care for older people living in Victoria’s residential aged care homes. Through our wideranging and extensive consultation we have designed a bill that has listened to industry concerns and meets community needs.

In response to direct feedback from the non-government sector, from the commencement date of 1 July 2026 a 90-day period will be allowed where there will not be any enforcement action by the health regulator. We understand that unforeseen circumstances can influence nursing staff availability, whether that is through resident emergency, unexpected staff shortages or other factors that can impact on a nurse’s ability to administer medication. For this reason, the bill provides the power to make regulations to prescribe circumstances where the obligations will not apply. While this will be further consulted on as part of the regulation-making processes, the current policy intent is to account for unforeseen circumstances that impact nursing availability. This is not intended to cover rosters with insufficient nurses, but rather unplanned situations that may occur from time to time, and it will be circumstances as defined in regulation, rather than providers needing to apply for exemptions. It is part of a range of measures that both the government at a Commonwealth level but also here in Victoria have been making to improve the aged care system.

One of the most significant things that we have seen in recent years has been the very significant pay increase that has been provided to the aged care sector by the Fair Work Commission. We very much welcome the Commonwealth Labor government’s decision to fund those reforms and the extra work that the Commonwealth government is doing to improve the supply of workforce and the supply of aged care across the government and non-government sectors. I think both the recognition and value of the work that workers in the aged care sector do and the remuneration that is being provided to support that work and demonstrate the respect, putting our money where our mouth is, so to speak, is demonstrating that there is more support for the aged care workforce, particularly coming from the Commonwealth government, and that that, according to the sector itself, is demonstrating that it is becoming easier to attract and retain aged care workers. I absolutely welcome the efforts that are being made to better support the aged care workforce and to keep more aged care workers in the aged care workforce being done at Commonwealth level.

In addition to that, the state government here in Victoria has some ongoing initiatives, incentives and policies to support and increase the nursing workforce, including in aged care. We have got our Diploma of Nursing being made available under the Victorian government’s free TAFE initiative, which will increase the pipeline of enrolled nurses for government and non- government healthcare sectors. I do want to acknowledge, particularly in light of the support that the Victorian government provides to our TAFE sector, those members of the TAFE sector that are joining us in the building today to celebrate the wonderful way that free TAFE delivers vocational pathways and career opportunities for more Victorians. The nursing sector is just one of those opportunities that the Victorian government is supporting, particularly through our support of the TAFE sector here in Victoria. In addition, we also have other initiatives, like the Making it Free to Study Nursing and Midwifery initiative, which have aimed to increase the public sector nursing workforce, including in our public sector aged care services, and there is obviously support for nurses in the landmark pay rise in the nurses and midwives enterprise agreement, which across the board should be expected to support the attraction and retention of nurses in the government aged care sector.

There is also $95 million over four years in the 2025–26 state budget to support the health workforce in Victoria through initiatives, including registered undergraduate students of nursing transitional support programs and capacity development for rural nurses. These are some of the measures that this Labor government is taking, because we know that as older people enter the aged care system with increasing and complex health conditions, this requires nuanced and tailored approaches to care for their unique needs. We want to make sure that older people living in aged care receive the best and highest skilled care from our talented, hardworking registered and enrolled nurses. We want to make sure that older people are not needlessly going to the emergency department because their medication was not dispensed or administered properly. We want to make sure the healthcare system is there for them. Older Victorians deserve to have access to the best quality health care, medicine and medical professionals but also access to a quality of life that they deserve. That is what is fundamentally at the heart of this bill, and I commend the bill to the house.

John BERGER (Southern Metropolitan) (15:41): I rise to speak in support of the Drugs, Poisons and Controlled Substances Amendment (Medication Administration in Residential Aged Care) Bill 2025, which when enacted will amend the Drugs, Poisons and Controlled Substances Act 1981. Now to the wording of the bill itself, it will provide for the administration of drugs of dependence of schedule 9, schedule 8 and schedule 4 poisons to persons accessing funded aged care services in residential aged care homes and make amendments consequential to the repeal of the Aged Care Act 1997 and the enactment of the Aged Care Act 2024 of the Commonwealth. Furthermore, in line with the amendments made to the federal legislation, changes will be made to the language used to align with national standards.

Victorians in residential aged care facilities deserve to be treated with both dignity and the highest level of medical care, and it is critical that those who provide residents with medication are trained and qualified to the highest standards. Through amendments of the act, only registered nurses, enrolled nurses with specified qualifications and other authorised registered health practitioners will be able to prescribe schedule 4, schedule 8 and schedule 9 medications on prescription. With Victorians increasingly choosing to enter residential aged care at later ages and with more complex medical requirements, it is critical that medical professionals in the industry are able to provide the best standards of care. Schedule 4, schedule 8 and schedule 9 drugs are all substances that are monitored and distributed with care. Respectively, they are prescription-only medications, controlled drugs with risks of dependence and prohibited substances only approved for medical and scientific research. Through the Royal Commission into Aged Care Quality and Safety in 2021 concerns were raised regarding inappropriate administration of routine medication. In 2020 the Pharmaceutical Society of Australia determined that around 20 per cent of unplanned hospital admissions by aged care residents resulted from incorrect medication administration, and that is a staggering number. With Victorian seniors entering care with increasingly complex medical needs, care must be taken to prevent concerns such as missed dosages and adverse drug reactions. From July to September 2024 it was determined via national data that 36 per cent of Victorian aged care residents were prescribed nine or more medications, and the types of medications impacted in this bill – schedules 4, 8 and 9 – largely have either high risks of interaction or other potential for dependence, which requires training and other care in order to ensure that they are administered correctly under accurate and quality medical advice.

Residents will retain the right to administer their own medication if they officially consent, and if they are determined to hold the capacity they do so through regular clinical assessments. This bill does not intend to change this right, but what this bill will do is ensure that residential aged care facilities are providing sufficiently qualified staff to administer medication as required. Compliance standards are being amended, as was mentioned earlier, as to who can administer these medications. It will be a criminal offence worth 100 penalty units for all providers for noncompliance without a reasonable excuse. This is to ensure that Victorians get the very best care that they deserve, and pay for, and that the quality of their care lines up with the community’s expectations. This will not apply in circumstances where these medications are self-prescribed by residents or where there is a notated exceptional reason for noncompliance. This could be, for example, a genuine risk to the resident from a delayed or misused medication if qualified staff are unavailable. This ensures that residents that need medications as a matter of urgency or necessity are not inhibited by any shortfall in the number of available qualified staff. Nor will the changes in this bill impact the capacity for registered practitioners with existing authorisation under the act or regulations, such as GPs, geriatricians, pharmacists or dentists, to prescribe or administer medication to aged care residents.

The Allan Labor government recognises that these changes will disrupt the standard operations of aged care providers, and upon commencement of these changes to compliance standards on 1 July 2026 a 90-day grace period will be provided for residential aged care facilities to amend their procedures and operations before any action is pursued. But these changes matter, because the safety and quality of life of Victorian seniors in aged care facilities cannot be neglected.

This bill comes from many years of investigations and consultation with key stakeholders and expert bodies, including public sector residential aged care services, Ageing Australia, the Victorian Healthcare Authority and the unions who advocate for aged care workers, including the Australian Nurses and Midwifery Federation and the Health Services Union, as well as the federal government and the regulatory bodies that provide oversight over aged care standards and compliance. I would like to thank all the individuals and organisations involved in this process for providing crucial advice and expertise to ensure these changes are appropriate for the sector today and in doing so providing the highest standards of care for seniors in Victorian residential aged care facilities, building upon the work already being done at a national scale, such as mandatory care minutes increasing the dedicated care and staffing targets in these facilities from October 2023, including 44 minutes of one-to-one care for residents by a registered nurse. Victoria’s largest public aged care facility, the Boollam Boollam Aged Care Centre, was recently completed – a $139.6 million facility, creating 247 construction jobs with a capacity of 150 residents, providing modern single rooms inclusive of private ensuite bathrooms for residents with complex medical care requirements.

These legislative changes could not have been introduced at a better time, with a $34.6 million investment through the Victorian state budget in 2025–26 to deliver quality aged care across the state as well as $7.5 million to upgrade existing facilities. Reforms like this one are only ever made possible when you have a strong, skilled and sustainable nursing workforce. An important part of maintaining that is ensuring that we are recruiting, retraining and upskilling our nurses. Backing our nurses and doing everything we can do to recruit more of them might seem like a fairly uncontroversial thing to do. It might seem like one of the most obvious things the government could do when faced with the challenges in the healthcare and aged care system that we face today and will face into the next few decades. In fact there was a health minister in a past Victorian government, still within living memory, that wanted to cut nurses’ numbers and replace them with health assistants. It is an incredible thought that we once had a government in this state that believed that the health system and the aged care system would be better off if we had fewer nurses around the place.

When past governments have gone into battle against our nurses, the people who have suffered the most are the patients in the healthcare system and those residents in the aged care system, people who know better than anybody how important our nurses are and how impactful their work is. They are the most vulnerable in our community and the ones who need it more than anyone. That is why the Labor government takes supporting our healthcare workers seriously. We all know that what responsible governments do when health and aged care are under pressure nationwide is invest in our healthcare and aged care workforces. Nurses are a critical part of all of that, which is why some of the Allan Labor government’s initiatives to continue to grow the nursing workforce are just so crucial to the system’s long-term sustainability.

Making nursing free to study under the Allan Labor government’s free TAFE program will help boost the workforce in public and private sector health and aged care services; and having more qualified nurses will mean patients get the care they need and the quality they expect. We also implemented the making it free to study nursing initiative, which is aimed at these most prominent aspects in scholarships for undergraduate nursing students. But those initiatives also included other important measures such as re-entry and refresher pathways for those who had left the sector, as well as a graduate sign-on bonus and more funding for graduate positions. We need more nurses across the healthcare sectors, and one way we can get them is to provide these sorts of incentives to people to make the career as attractive as possible.

Another thing that made a lot of us on this side of the chamber especially proud last year was when we reached a deal with the Australian Nursing and Midwifery Federation to give public sector nurses a 28.4 per cent pay rise over the next four years. After all the work they did during the difficult years of the pandemic, I think we can all agree that they deserve this. The Allan Labor government will always stand on the side of workers having a fair go, and that includes our nurses who worked long hours every day while COVID spread throughout the community. We have also strengthened nurse-to-patient ratios in Victoria: back in 2015, we became the first state government to introduce safer nurse and patient ratios, and the Allan Labor government made it even stronger this year. It is good for patients who get the care they need and the assurance that there will always be a nurse available to help them, and it is good for the nurses who already have long working hours managing a lot of patients, who will now be supported with more qualified nurses thanks to the efforts to grow the workforce. We have also made it easier for diploma of nursing students to work in the sector while they complete their studies. This is something that benefits the system itself by providing more workers, but it also benefits students, allowing them to earn an income while they study.

Everyone stands to benefit from these crucial reforms. The challenges we face in the healthcare system are not going to go away and are going to become more difficult and more complex over the next few decades. That is why it is important that these investments, which need to be made at some point, are being made now. In fact we are not just making them now in 2025 – we have been making them ever since we first came into government back in 2014. Victorians deserve the security of knowing that the system that supports them and their families today will still be there in the coming decades. If we want to be able to implement this bill and ensure that the sorts of medications we are dealing with are being administered by registered nurses, then we need to ensure that we have the workforce necessary to service this requirement. But this is not necessarily just about creating further demand for nurses, this is about the smarter use of existing resources. As I mentioned earlier, it is estimated that 20 per cent of unplanned hospital admissions coming from residential aged care facilities are the results of inappropriate use of medicines. So if we can get this right, this amendment to the act, and we are able to reduce the number of hospital admissions being caused in these ways, we will be able to take a little bit of pressure off our hospitals.

Remember, maintaining long-term sustainability for our hospital system means increasing the availability of care but also helping prevent people from needing a hospital in the first place. We see implementing this requirement for a registered nurse to administer certain types of medication as a way to ensure that they are administered by those with the expertise to do so. It is also important to ensure that medical problems are not made worse by the incorrect use of these medications, leading to developments that might require them being moved to a hospital. Of course we recognise that in some situations it is impossible for a registered nurse to be able to be onsite to administer the medication, which is why it is so important that this bill provides for the creation of regulations around situations where nurses cannot be in place. It is simply not possible for nurses to be everywhere at any given time, and we do not want the law change to inadvertently put pressure on nurses to be in multiple places at once or to work themselves day in, day out, because this bill is about improving the quality of medical care received by aged care residents, not about making the lives of nurses harder and their work hours longer. This bill follows the principle that it will always be the most qualified person available who administers these sorts of medications, which is why we are legislating that it should be a registered nurse. But in cases where the medication needs to be administered immediately and no nurse is available, we want to ensure that a protocol exists to cover these sorts of situations, even if we hope that it will only need to be used occasionally.

This bill is about ensuring that patients get the care that they need. They deserve the very best care, and this bill will help bring it up to community expectations. We are continuously improving and building on our healthcare system in Victoria, with a long list of reforms delivered by this Allan Labor government over the past decade. These reforms are centred on ensuring patients and the public get the best possible care from our hospitals and on ensuring that our workforce is looked after. Nurses are the backbone of our health system, often working long hours juggling a long list of patients, and this bill ensures that patients get the medication they need without overworking and backlogging the work that nurses do for all of us.

The approach of these reforms by the Allan Labor government is in stark contrast to the era of cuts and closures under previous governments, because this government puts Victorians first and leads the country with our reforms. On that I commend the bill to the chamber.

Michael GALEA (South-Eastern Metropolitan) (15:56): I also rise today to speak on the Drugs, Poisons and Controlled Substances Amendment (Medication Administration in Residential Aged Care) Bill 2025. As has been canvassed by a few other speakers on this side already, the purpose of this bill is to improve the quality and the safety of care for older people living in our state’s residential aged care homes.

Aged care is about how we treat the people who raised us, who built our communities and who shaped the Victoria that we know and love today. It is about the care and dignity that we provide to our mums, dads, grandparents and, as a matter of fact right now, my nanna, who is in an aged care facility in northern Victoria receiving excellent care from her facility there, and I would like to take a quick moment to acknowledge all the amazing staff at that facility and the incredible work that they do – it is no small task. Every Victorian family wants to know that when their loved one enters an aged care facility they will receive not just shelter, not just food but genuine, safe, respectful, warm and professional care.

This bill today will deliver a significant reform that will better ensure that the medication that is given to these people living in aged care facilities is handled only by those with the training, the skill set and the clinical judgement to do so in a safe manner. It will achieve this by making amendments to the Drugs, Poisons and Controlled Substances Act 1981 so that only registered nurses, enrolled nurses with specified qualifications and other authorised registered health practitioners will be the ones to administer drugs of dependence and schedule 4, 8 and 9 medications to people in residential aged care for whom the medication has been supplied on prescription. These changes reflect the Victorian government’s commitment to reducing the risk of medicine-related problems in residential aged care.

I will take up a comment made by Mr Berger, actually, in relation to nurse-to-patient ratios. It is certainly a good point indeed that we do have the federal minimum care minutes, but I do note as well indeed that it is Victoria again, this state, that is leading the way, leading all other jurisdictions, when it comes to nurse-to-patient ratios in other healthcare settings such as hospitals. Indeed, after seeing some vicious attacks on the working conditions of nurses in the former Baillieu–Napthine governments a while back, when this government came in in 2015 it was legislated that those nurse-to-patient ratios would be fixed in law, and then they were indeed again strengthened just earlier this year – very important steps to support the people who do so much to support all of us. Those nurses do incredible work, and it is a good thing that in Victoria the nurse-to-patient ratios and the other various metrics of the care that is provided to patients exceed not just the targets but the national average and indeed other jurisdictions across the country as well. That is a testament to the work of our nurses that is supported by the significant investments both in legislation of course but, more importantly, in the resourcing of our nurses from this government.

When it comes to prescribing medications, including schedule 4 medications, we know how important it can be to access the medications that you need when you need them. That is why it is so important that through the state budget this year we have seen the expansion of the community pharmacist program, which is now going to be expanded to 22 services. All Victorians will be able to go to their pharmacist and have a consultation. Unlike other states where this program has been rolled out, in Victoria that consultation will be completely free, so effectively bulk-billing, if we were to use that terminology. Not only does it save a trip to the doctor, freeing up that other very important primary care resource so they can attend to other and more critical needs, it means that you can have that chat, that consultation with your pharmacist who is enrolled in the program completely free of charge, as I said, in Victoria, unlike other states, whether it is for shingles, for psoriasis, for an oral contraceptive or indeed for an uncomplicated urinary tract infection. These things are just some of the examples of conditions that can be treated through the community pharmacist program with that free-of-charge consultation providing more and easier access and also, importantly, reducing the cost of living for all Victorians to access the health care that they need.

Indeed when it comes to purchasing many of those prescription products, we have also seen – and I will take this opportunity to welcome a very significant announcement by the Albanese federal Labor government, who recently announced new legislation – that the cost of medications under the PBS is to be dramatically slashed, in fact by about 20 per cent, as of 1 January next year. The cost of that, which is currently set at $31.60, will now be reduced to $25. It is a very significant step, an important further step, to ensure that Victorians, and indeed in this case all Australians, have access to the medication that they need and that it is not going to hit them in their hip pocket. Whether it is at state level with the nurse-to-patient ratios or whether it is supporting our paramedics, our nurses and our medical professions – unlike going to war with them, like Mr Davis did when he was in office – we have seen that at the state level Labor governments support the healthcare system. They support patients, and they support the people who give their lives to that care: the nurses, the doctors and the other incredible support staff that work across a myriad of ways in our healthcare services.

It is indeed good to see, after nine bad years at the federal level of attacks on bulk-billing – attacks time and time and time again undermining the bulk-billing system so that it was pretty much on its knees and on the edge of extinction at the end of the last federal Liberal government and the myriad of prime ministers that they had as well – that we have had significant investment into Medicare, into primary care and into bulk-billing from the Albanese Labor government as well.

As members in this place will know, Victoria was not prepared to wait for the end of that disastrous government to implement improvements to the primary care system. Even though primary care is a responsibility of the Commonwealth, Victoria, along with New South Wales – a Liberal government at the time, I add – stepped in with the implementation of primary priority care centres, otherwise better known by the name of urgent care clinics. It has been wonderful to see that the federal Labor government – a government that actually does care about primary care – has now stepped in and is now co-funding 17 out of the 29 urgent care clinics operating across Victoria, with the remainder of the funding coming from the state government, because we recognise that whichever part of the healthcare system that you are looking at, primary care is such an important part of it. It is such an important component of getting things right before they go wrong down the track. That is why the urgent care clinics have been such a resounding success, with I believe around about 8000 visits a week in the state of Victoria to urgent care clinics. We heard from the then Secretary of the Department of Health in the Public Accounts and Estimates Committee financial and performance outcomes hearings late last year that, from the survey and the research that they have done, around 50 per cent of those patients would have otherwise gone into emergency departments, adding pressure to those services, or the other 50 per cent would not have sought care in a timely fashion, which is very, very problematic for those people and would have led to, for many of them, significantly worse health outcomes.

The urgent care clinics provide a really, really important tool in that step between primary care and tertiary emergency departments. That is why it is so important that Victoria, along with New South Wales, pioneered these clinics in the midst of a complete vacuum of leadership from the former federal Liberal government. Now that we have a federal government that is prepared to support health care in this country and support health workers as well, Ms Crozier, we now see some federal funding towards this as well –

Georgie Crozier interjected.

Michael GALEA: and it is a very important part. If you were listening, Ms Crozier, you would have heard me give some credit to the New South Wales Liberal government as well, which, along with Victoria, implemented those PPCCs as they were then called, now the urgent care clinics. But they are an important step, as is primary care at the level of GPs, as is the pharmacists and the pharmacies themselves. Each year members of the pharmacy industry come into the Parliament to talk to us about the various things that they are up to, but also to offer flu shots and other things like that. It is a great experience, and I will give a shout-out to Carolyn, who is in fact a pharmacist from my region who often comes in for that program. It is always good to see her here in the Parliament.

Whatever range of the healthcare system you are looking at, it is important that we are making those investments because it is all interrelated. Whether it is the federal intervention of reducing the PBS co-payments from 1 January next year – a 20 per cent reduction in what users will have to pay – whether it is this state government implementing nurse-to-patient ratios, legislating them and improving them in further legislation or whether it is in the community pharmacist program, we are seeing that investment.

On this particular matter, we know how important it is to get residential aged care settings right. Again, coming back to the various types of medications, we know that people in these aged care settings can often have complex needs. Typically, they are entering these facilities at a later and later age. The result of that is that the residents who are there are more likely, as a proportion of the total cohort, to have more complex health conditions, which can become increasingly difficult or in some cases impossible for them to manage on their own or in their own home safely. We know that they are needing that assistance more often, which again goes to underscoring the importance of nurse-to-patient ratios, or in this case the federal minimum care minutes in aged care facilities.

We know that recent Commonwealth data shows that 36 per cent of people living in Victorian residential aged care facilities are prescribed nine or more medications, which is the highest rate of polypharmacy in the country. In addition, the data shows that 19 per cent of these residents receive antipsychotics. The bill before us today and the principal reform to the administration of medication are in large part a response to the 2021 Royal Commission into Aged Care Quality and Safety, which identified medication mismanagement and safety in residential aged care as an essential area for improvement. Noting again that whilst at a principal point of view aged care in this country is a responsibility of the Commonwealth, there are a large number of intersections where the state has a role to play, and the bill before us is an example of one such particularly pertinent point of that, which is in relation to the dispensing of medications.

We know that the royal commission drew attention to various incidents of inappropriate management of medication regimens, including in some cases medicines not being administered correctly and residents being given tablets without oversight in some cases to ensure that they were actually swallowed. It was clear from the report that the prevalence of residential aged care not meeting community and medical care expectations was far too routine. The mandatory care minutes that I have discussed earlier were introduced in response to the royal commission to ensure that older people in aged care homes receive the dedicated care time they need, and again I acknowledge the work of the federal Albanese Labor government to implement them.

It has been a long time, indeed about eight years, since Victoria had first legislated nurse-to-patient ratios, and I recall as far back as 2018 being out talking with voters in the then seat of Gembrook, in the federal seat of Latrobe, and people coming to us and saying, ‘We have this wonderful thing for nurses, why do we not have it for aged care?’ It was a very good question. It was a good question then, and it was certainly a question that became all too obvious and relevant in light of the findings of the royal commission. It should not have taken that royal commission in order for that to be implemented. The former federal Liberal government could have, of course, implemented it had it chosen to do so, but we know that they are not invested in healthcare outcomes for older Australians, just as they are not invested in healthcare outcomes for any Australians, and that certainly rings true today. Only a Labor government will deliver on those things, and only a Labor government delivered those mandatory care minutes in the aged care settings. Indeed, it is good to see them taking those steps towards the level that we have in nurse-to-patient ratios in Victoria, noting again that they are still, by some measure, nation leading.

Since October 2023 those providers have increased their staffing profile to meet the targets, which include 44 minutes of direct care by a registered nurse. There are also further Commonwealth reforms in relation to this royal commission, such as the implementation of the Australian national aged care classification funding model, which does see those providers have greater certainty over their funding and, more appropriately, that appropriate amount of funding to meet the needs of their residents. Here in Victoria the state government will continue to do the work it needs to do to support aged care residents, and this bill is a very important part of that.

Ingrid STITT (Western Metropolitan – Minister for Mental Health, Minister for Ageing, Minister for Multicultural Affairs) (16:11): I do thank all members for their contributions in relation to this bill. In 2022 the government made a commitment to amend the Drugs, Poisons and Controlled Substances Act 1981 so that only those with the appropriate education and training – nurses and registered health practitioners – could administer medication in residential aged care. The bill will lead to improvements in the quality and safety of care for older Victorians living in our residential aged care homes, and they are very consistent with and complementary to the reforms being undertaken by the Commonwealth government. These changes are good for older Victorians, putting their safety first, making sure they receive the right medication safely and at the right time from the right professionals. These changes are good for our nurses and personal care workers, who will have the appropriate knowledge, skills and capability to provide the incredibly important care that they do, whether that is to meet the emotional, social or physical care needs of residents. The changes will be good for our health system, with reduced risk of harm from avoidable hospital admissions due to medication maladministration, taking pressure off the system and saving hospital beds for those that need them.

I note that Ms Crozier has raised a few concerns on behalf of some providers, and she is concerned about how providers will meet the requirements contained in the bill. She has some concerns that the workforce is not there to implement the reform and that the government has not done the work to understand the implications. I just want to take a moment to address the key aspects of that. The Victorian government has consulted extensively since 2022 regarding the scope of the reform with peak bodies, including Ageing Australia, the Victorian Healthcare Association, unions, including the Australian Nursing and Midwifery Federation (ANMF) and Health Services Union, and the Commonwealth government, including the regulatory bodies that oversee aged care. There has been significant input from non-government sector providers, who have been consulted and have contributed to the development of this bill. Through this engagement with providers, I understand that some providers are already commencing changes to their model of care, with nurses now administering most medications.

The department has worked with the sector to develop an implementation approach that waits until after significant Commonwealth reforms have been implemented before commencing this new requirement on 1 July 2026, so we are providing that time for the sector to get ready. Since October 2023 legislative requirements to meet Commonwealth RN care minutes, including 44 minutes of direct care by a registered nurse and RN 24/7 requirements, have increased the nursing workforce profile within our homes. Mandatory care minutes, as a number of my colleagues have mentioned, were introduced by the Commonwealth in response to the Royal Commission into Aged Care Quality and Safety to ensure that older people in aged care receive the dedicated care time they need and deserve.

Victorian providers, both public and private, are overwhelmingly meeting or exceeding their direct care minutes requirements and the requirements to have an RN on site 24/7. So 84 per cent of Victorian providers reported meeting at least 95 per cent of the mandatory direct care minutes. Ninety-two per cent of facilities reported meeting 24/7 registered nurse requirements. Ms Crozier, of note to you I think, of the 8 per cent of facilities not meeting the 24/7 requirement, more than half were within 30 minutes of the requirements. So those Commonwealth reforms are being bedded down significantly. Drawing on the data from an early 2024 survey to government and non-government providers undertaken by my department, it is estimated that at that point in time medication was administered by an RN or EN 91 per cent of the time in public sector residential aged care facilities and 81 per cent of the time in non-government sector providers. Since this survey was conducted, the Commonwealth workforce initiatives have continued to see an increase in care delivered by nurses in residential aged care.

Further Commonwealth reforms to funding residential aged care and the implementation of the Australian national aged care classification funding model have seen providers have greater certainty over their funding and more appropriate funding to meet the needs of their residents. This change has allowed for adequate staffing levels to provide quality care for residents. Rural and regional facilities receive a higher daily rate for funding depending on the classification and their location, and in addition, eligible facilities under the funding model also receive a supplement for the RN 24/7 requirements. So there is additional Commonwealth funding going into aged care. The government expects as a result nurses are now administering medication even more frequently than the 2024 survey indicated. In addition, 2025 consultation with the sector indicated many providers are already making changes to the models of their care to embed the role of medication administration within the nurses’ core responsibilities.

Pending passage of the legislation, the department will resurvey the sector to inform the development of the regulations and change management supports for the sector. The six-monthly surveys will then contribute to, Ms Crozier, a four-year review of the reform, alongside other available data, information and insights, and I think that is an important point. We are not going to wait for the implementation of the bill next year, in July. We are going to start the work with the sector immediately, should this bill pass the house, so that we can get on with getting our providers ready for the change. The survey will provide regular feedback on to what extent providers are complying with the reform. Any unintended consequences and any opportunities for improvement we will take on without delay. The ongoing surveys will enable regular feedback, as I have indicated, and an early review would not allow sufficient time for education for providers to understand their obligations and to work through potential workforce changes. But I think that a four-year review will provide an adequate amount of time to gather the appropriate data and insights. Similar to the Aged Care Restrictive Practices Substitute Decision-maker Act 2024, which we passed last year, this is not a legislative review but a departmental review. I want to thank my department for the way in which they have been actively engaging with the sector on these reforms.

The opposition has also raised some issues with the enforcement model, which is consistent with other elements of the Drugs, Poisons and Controlled Substances Act. The health regulator will adopt a risk-based and responsive approach to enforcement, with a priority focus on addressing significant harms from non-compliance. The government’s focus is on supporting providers to comply and deliver high-quality care through medication administration. Should noncompliance be established, the health regulator has discretion to first consider education with the provider or issue an improvement, enforceable undertaking or prohibition notice. So there are a series of steps that can be taken, and prosecution may occur when noncompliance is persistent.

The health regulator will take an education-first approach prior to other instruments such as an improvement notice, enforceable undertaking or prohibition notice. Should a serious risk of adverse harm occur and a provider be found to have been noncompliant with the requirement, the provider is likely to be subject to prosecution and possible criminal penalties under the proposed bill. Consultation with the sector will also continue as part of making regulations to allow for circumstances where the obligation will not apply if there is a risk of harm to a resident from delayed medication. With time to prepare, the reform will not commence, as I mentioned, until 1 July 2026, and there will be a 90-day grace period where no enforcement action will be pursued. The government in this way is enabling additional flexibility for those providers that need to make change.

I want to take a moment to thank the valued stakeholders that I mentioned earlier for their meaningful input into this reform. I also want to acknowledge the tireless advocacy of Lisa Fitzpatrick, who has recently retired as secretary of the ANMF this year, leaving an incredible legacy to Victoria’s nurses, midwives and personal care workers.

Medication administration is a core nursing responsibility, and it is a critical aspect of safe, person-centred care. Nurses are often the final checkpoint before a medication is given, ensuring it is correctly prescribed and dispensed. This requires medical literacy, physiological understanding and knowledge of how medications affect older people – skills that nurses develop throughout their career and their education. Importantly, medication administration is not an isolated task. In aged care it offers nurses a valuable opportunity to assess a resident’s physical and psychosocial wellbeing, monitor therapeutic responses and identify evolving care needs. These insights directly inform and enhance the quality of care provided.

I do understand that members may have some questions in committee, but can I also thank members for their engagement in relation to the provisions contained in this bill. I commend the bill to the house.

Motion agreed to.

Read second time.

Committed.

Committee

Clause 1 (16:23)

Georgie CROZIER: Minister, thank you for your summing up and providing some clarity around some of those issues that we have been discussing over recent days and also for starting I think the survey or the assessments with providers now, not when this bill actually commences next year, and also for reviewing that timing. Despite that, I still have concerns around the timing, and I will come to that. But I would like to just go to a couple of points around the workforce issue, which has been of concern to me and a number of providers. I am wondering: you have said that there is work being undertaken and that nurses will be undertaking this work, so what modelling has been undertaken, particularly for regional areas, regarding the availability of registered nurses (RNs) so that providers can comply with the legislation?

Ingrid STITT: I think I went to a couple of those points in my summing-up, but for completeness, there has already been, as I mentioned, extensive consultation with the sector undertaken by my department, and then there was a survey conducted in 2024 to get a deeper understanding of, across the sector, including private, not-for-profit and PSRACS, the public sector residential aged care services, what classifications of the workforce were providing medication administration currently. Those were the statistics that I read out earlier, which were that 91 per cent of medication administration in PSRACS was being administered by nurses – RNs or enrolled nurses – and 81 per cent in the other providers, the not-for-profits and the private sector providers. Since that survey there have been a number of reforms that have been implemented through the Commonwealth reforms, including the care minutes and the requirement to have a 24/7 nurse. That is one of the reasons why my department is very keen, should the bill pass the house today, to immediately get on with the task of surveying the sector again so that we have a baseline of data and we can be confident about what targeted supports are going to be required to bed down these reforms across the sector.

Georgie CROZIER: Just with that extensive survey that was undertaken in 2024 – and you have got that data back – one of the key stakeholders has said to me that they were provided with information from the government that this bill was coming in but there was really limited input. Was that the consultation that you referred to and many of your backbench MPs have said was extensive consultation? Is that the survey area that you are speaking of? Is that the only consultation that was done?

Ingrid STITT: Ms Crozier, that was only one element of the engagement that the department has undertaken with the sector. There was that 2024 survey. There were also quite a number of visits to aged care homes and various meetings, round tables and discussions with representatives of both non-government and government parts of the sector, and the department has actually just continued to engage with the sector as part of making regulations. I think I mentioned in my summing-up that there will be further consultation around the exclusions that will be detailed in regulations. So there was consultation from 2022, then further consultation with the sector in 2023 and 2024. I would not want you to get the impression that it was only the survey that was undertaken. There were other significant discussions that occurred.

Georgie CROZIER: If I could just go back to that point that you made: 91 per cent in the public sector and 81 per cent in the not-for-profit and private sector that are adhering to the nurse administration – is that correct?

Ingrid STITT: Yes, that is right, Ms Crozier. That is the data that came back from the sector.

Georgie CROZIER: So you are aiming for 100 per cent, correct?

Ingrid STITT: We are taking a sensible and staged approach to supporting the sector implementing these changes. The bill would not commence until 1 July 2026, and then there would be an additional 90-day period when there would be no enforcement penalties applied. The regulator would take a very educative-based approach to getting the sector ready. At the end of the day it is in everybody’s interests for these reforms to work, because they are about the safety and care of our residents in aged care.

Georgie CROZIER: I agree. I think everybody is in agreement and understands the intent of that. What is the government’s assessment of the numbers of registered nurses or enrolled nurses that will be able to undertake this legislative requirement? What is that figure? And is there a breakdown for the regional areas and the metropolitan areas that the government has identified?

Ingrid STITT: That is not a straightforward one to answer, because the government do not hold the data for not-for-profit and private providers. I can give you figures for the public sector workforce if you would just let me get my fingers on that particular information, but we have relied heavily on working with the sector to get the data through surveys and through consultation that we have been undertaking through the department since 2022. There we go; I have got it. So in our public sector residential aged care – and bearing in mind this is data from 2021–22, so I will have to take on notice whether we have got any more recent data available – we have a total of 4356.36 FTE workforce; over 850 are registered nurses and over 1590 are enrolled nurses.

Georgie CROZIER: Thank you for that clarification. Yes, those figures are probably somewhat outdated, I suspect, but it gives an indication. The reason I ask this is: given the surveys, surely that is one of the issues the government would want to identify with the not-for-profits and the private sector, exactly as you have just given to me – that FTE in the breakdown, understanding that it is not going to be static, because of workforce conditions and just the practicalities of what occurs. But surely the government with those surveys have asked the sector: can you meet the requirements of what we are proposing, and if not, what is the workforce shortage? Was that not asked of the sector in that consultation process?

Ingrid STITT: Of course workforce came up quite a bit in the development of the bill and in the – I think I would describe it as pretty constructive – engagement between my department and the sector peaks and operators. The survey is really but one part of the picture. I think that when you combine – I do not want to be repetitive, but it is important – these reforms with other reforms that the Commonwealth are introducing that complement our reforms, with the care minutes and with the 24/7 requirement for an RN; when you also look at the Fair Work Commission decision recently to award a pay increase in the aged care sector, which has really improved the ability of services to attract and retain their workforce; when you consider that our PSRACS already have good wages and conditions, secure employment and nurse-to-resident ratios; and when you add that to some of the other workforce initiatives that the Victorian government has funded, such as the diploma of nursing being available through TAFE, making it free to study nursing and industrial arrangements that make it more attractive to work in these sectors that have historically been undervalued because they are dominated by women, plus additional workforce initiatives that we have provided in the 2025–26 budget to the tune of $95.1 million to support our health workforce – when you combine all of those things, my department are very confident that these reforms will be able to be implemented effectively, given that we are not coming off a ground zero base already. Our services are saying that in over 80 per cent of the time nurses are already doing this work in the not-for-profit and private providers. That is one of the reasons why we are going to give time for these reforms to be implemented effectively. But certainly workforce has been a key consideration of the government in shaping the bill.

Georgie CROZIER: Minister, some weeks ago, there was an article in the Herald Sun which said the government had indicated that 650 staff would be required. Is that your understanding? Where did that number come from? On 31 July it was in the Herald Sun article.

Ingrid STITT: Yes, I did see that article. That is not current data. We estimate that, as I have indicated, 81 per cent of not-for-profit and private sector providers are already administering administration through the nursing classifications within their workforce and 91 per cent in PS ranks.

Georgie CROZIER: I will leave that there around the workforce. I do have problems around it. I do have problems around the fact that there have been these figures reported on. I do have a concern that you are saying 81 per cent and 91 per cent. You have said that you have surveys that are going out, saying you have done extensive consultation, and therefore I am a little concerned that you do not have an overarching number like that number you could provide for the public sector with the current workforce. I do have concerns around that, because I do think that is a very significant issue for the not-for-profit and private sectors. They need to be able to plan and support their providers with this model that is going to be put in place. I think they would appreciate any updates on that. But given the surveys that are starting, that is an improvement. So that is good because I am hoping the government will be able to get that information. I am not sure why they do not have it now.

Could I go to a point, Minister, that Ms Terpstra stated in her contribution? She said that residents receive medications from nurses 82 per cent of the time, and that is what you have just alluded to. So that is the public sector –

Ingrid STITT: No.

Georgie CROZIER: Sorry, private sector. I beg your pardon. Someone, I am not sure if it was Ms Terpstra but I think it was, spoke about the high rates of admissions from aged care services. I was just having a discussion with Mr Ettershank because he has worked in the sector, and I was also speaking about an example that I know of where an elderly resident who had Parkinson’s disease, whose medications were badly affecting both her physical and cognitive ability, had to be admitted into hospital to be stabilised and to have that sorted out. Now, that was not a nurse error. That was a doctor, physician, gerontologist prescribing error. So I am just wondering what the numbers are that you have got around the numbers of admissions from medication mismanagement or medication errors by nurses that a lot of this legislation is based on. Have you got the figures for Victoria?

Ingrid STITT: I can certainly see what I have got, Ms Crozier, in answer to that question. I know that the royal commission into aged care that the Commonwealth undertook did go into some detail around the maladministration, if you like, of medication being a significant problem. So I will see what actual data we have. But what I will say is that this is one of the reasons why it is important to have nurses oversighting the administration of medication, because even in the scenario that you have just put, having someone with that training and that ability to pick up on adverse –

Georgie CROZIER: I am not disagreeing.

Ingrid STITT: No, I know you are not. I am just making the point. This is the whole reason why we would want to make these reforms. Just let me check with the box if we have got any numbers on hospital admissions.

Ms Crozier, what I can share with you is some research that our friends at the Pharmaceutical Society of Australia undertook in 2020. They estimated that 20 per cent of unplanned hospital admissions from residential aged care are a result of inappropriate medicine use. Now, that is obviously not a kind of headcount for Victoria, but an overall figure for Australia.

Georgie CROZIER: That was national.

Ingrid STITT: Yes, that is right. And in 2021 the AMA estimated nationally $21.2 billion could be saved in public and private health care from avoidable hospital presentations, admissions and stays from older people living in residential aged care and the community. So there has been some research into this issue. What I will also share with you is that we know that in Victoria we have much less ‘bed block’, which is a terrible term – older Victorians having to stay in hospital because there is no bed available. Our numbers are significantly lower, by a significant margin, compared to other jurisdictions because in part we do have access to public residential aged care beds across the state. We have also recently signed up to a number of strengthening Medicare initiatives with the Commonwealth, which is also about trying to avoid avoidable hospital admissions for aged care residents, and that is some of the great work of our nurses doing in-reach programs into service providers.

Georgie CROZIER: Minister, can you clarify whether this legislation is similar to other jurisdictions, or do other jurisdictions still have personal care workers administering certain medications – not the high-risk ones but more like antibiotics and the lower risk medications? Has Victoria deviated from other states in this regard?

Ingrid STITT: I can indicate, Ms Crozier, that in other jurisdictions, such as Tasmania, they have restrictions in place as to who can administer prescribed and dispensed medications in residential aged care. We have the reforms that are before the house today for Victoria. Each jurisdiction is responsible for its own drugs, poisons and administering of medication legislation, but certainly there have been recommendations made through the royal commission into aged care that this is an area that jurisdictions need to improve their safety mechanisms around, and that is one of the reasons why the government has pursued these reforms.

Georgie CROZIER: Tasmania use carers to administer those medications. Did the government look at any alternate models to assist in this, or are you just saying that the royal commission said, ‘This should be addressed. We’re going down this line. We’re not looking at other jurisdictions in terms of perhaps the readmission rates that they have or the issues that they have, like carers administering these medications in other jurisdictions’? Were any alternate models used or modelled on from other states or territories?

Ingrid STITT: What informed the bill were a few things, not one single thing. But there was a review that was conducted in 2018 that made recommendations. We also looked closely at the Commonwealth data. From July to September 2024, for example – and I think a few of my colleagues noted this in their contributions in the debate; we have got residents entering aged care older, with more complex health needs – 36 per cent of people living in Victorian residential aged care homes were prescribed nine or more medications, and that is the highest in the country. Certainly that was a factor in the government pursuing these changes. In addition, this was an election commitment that the government made in 2022, to change the legislation and strengthen the requirements around medication administration in residential aged care.

Georgie CROZIER: Just to go back to the issue around the providers, were any nurses surveyed, or was it just the providers that were surveyed? How were those surveys undertaken, and did nurses have an input into their work given they do provide other care? As I said in the second-reading debate, whether it is triaging of care and support, wound care, supporting family members, palliative care or looking at those emergency issues that arise in aged care facilities sometimes far too regularly, they are doing a range of things, not just administering medications. So did nurses have an input into this? Not through the union – I mean through the surveys that you did.

Ingrid STITT: I can indicate, Ms Crozier, that staff did participate in strong numbers in the 2018–19 review that was undertaken, which did include surveying the workforce. I take issue with you saying that the Australian Nursing and Midwifery Federation consultation is separate to the nurses, because they very much speak on behalf of tens of thousands of nurses, so they have been consulted throughout this process, yes.

Georgie CROZIER: I was not meaning that. What I was meaning was, with the surveys that were undertaken, did it not go just through to the union on their behalf? What I was meaning was, did the surveys go to the providers and the providers then spoke to their staff and they had an ability to participate directly in that manner? That is what I was meaning.

Ingrid STITT: I note that I was not the minister then, but obviously I have been provided with advice from my department. My advice is that providers were surveyed and that staff participated in that original review in 2018–19, including the survey. In 2022 nurses participated in round tables, so did providers. The survey went to providers and directors of nursing in particular. There was quite a bit of engagement with nurses, as you would expect.

Georgie CROZIER: I will not labour the point. Again, I will just go to the point that those surveys were conducted in 2018 and 2019. That was six, seven years ago. We have had COVID since then, we have had a whole lot of issues that have arisen because of the stresses through the system during that very difficult time. Therefore I am just a little perplexed that the department has not done a survey since that time and taken on board considerations following COVID. Is there any reason why they have not done a survey since 2018 and 2019?

Ingrid STITT: They have, Ms Crozier, in 2022 and 2024, in addition to the surveys that were conducted and the consultation in 2018–19, so there have been three separate opportunities for providers and their staff to have input. As you would expect, my department is not just relying on surveys to be returned, they are also actively engaging with key peaks and also sector providers and unions to make sure that we are getting the balance right here.

Georgie CROZIER: Thank you for that clarification. Can I just go to the funding, the $7.6 million I think it is that the government has provided to the public sector for implementation. What is the government’s intention, that that money will assist with implementation?

Ingrid STITT: That work will be conducted closely with providers, with PSRACS. It is really about making sure they have the support for change management in preparation for the reform.

Georgie CROZIER: Change management; the private providers obviously will be footing that bill themselves, or the not-for-profits. Has the government got any idea of what those change management costs would be to the not-for-profit and private providers, given they are a significant number of the workforce?

Ingrid STITT: We are going to continue to work with the non-government parts of the sector to understand what supports they need to implement these reforms. But as I took you to earlier, Ms Crozier, I think in my summing-up contribution, the Commonwealth – and it is great to have a partner in Canberra who is committed to continuing to invest in aged care, particularly given the shocking revelations in the aged care royal commission. Those rural –

Georgie CROZIER: That the coalition government initiated.

Ingrid STITT: Whoever initiated it, it was the right thing to do. The findings were shocking, and the investments that have been made to date, we absolutely welcome, because it is about strengthening the whole sector and providing appropriate care to vulnerable older Victorians. As I indicated in my summing up, regional and rural facilities will receive a higher daily rate for funding depending on their location. Through the Commonwealth funding reforms, there are additional eligible facilities under that funding model that can receive a supplement in addition to wherever it is they are located for the RN 24/7 requirement. It is not just support from the Victorian government, it is support from the Commonwealth as well.

Georgie CROZIER: I should have asked this at the outset, Minister. How many providers are there across the state – public, not-for-profit and private? Have you got those numbers, Minister?

Ingrid STITT: You will have to give me a minute to dig them out, Ms Crozier. Just one moment.

There are approximately 770 residential aged care facilities across Victoria, with approximately 60,000 beds. They are figures from December 2023, so we are relying on Commonwealth data for those figures. I am sorry that it is not more up to date, but we can check to see if there are more up-to-date numbers. 157 of those are public sector residential aged care.

Georgie CROZIER: Could we have also a breakdown of the number of surveys that were provided from the private, the not-for-profit and the public sector from 2018, 2019, 2022 and 2024? The department would have those figures.

Ingrid STITT: I will probably have to take that one on notice, Ms Crozier, but please be assured that in the work that the department will undertake to do a new survey to get a new baseline of data to support these reforms we will definitely be asking providers to give us that full breakdown.

Georgie CROZIER: I would appreciate that. I think it is important that we know how many responded to the survey out of those 770 in those years that you have told the committee that surveys went out so that we can have an understanding of the baseline. You would hope that the vast majority of the 770 would be responding given these reforms are coming into place, so I look forward to receiving those figures. I do not believe I have any more questions, Minister, so thank you.

David ETTERSHANK: Can I say, first of all, that Legalise Cannabis welcomes this initiative. We commend the government for biting on the bullet, and we commend the Australian Nursing and Midwifery Federation for their advocacy on behalf of their members and their sheer determination to chase this issue I think over about 20 years before they have finally run it to ground, so strength to their arm and blood to their brain.

We all have a vested interest in having the best possible aged care system – I think we can all agree on that – and I take on board the minister’s comments with regard to compliance with nurse minutes under the federal legislation; running at more than 80 per cent is really encouraging. But at the same time, as with most legislation, it is not the majority but the exceptions that are often the issue, and there are clearly issues with simply getting division 1 or med-endorsed division 2 nurses in many rural and regional areas. I recognise that the state plays an important role in filling those holes in rural and regional areas, but at the end of the day, the last time I looked, public sector residential aged care makes up about 8 per cent of the total beds in Victoria, so that still leaves the other 92. Quite clearly there are not-for-profits in rural and regional areas, and also in some inner-city areas, that have great difficulty accessing staff, particularly the div 1s and the med-endorsed div 2s. Also, notwithstanding the significant workforce initiatives that the government has undertaken through free TAFE and suchlike, and those are really good and important initiatives, I am told that in some regional and rural areas it can be difficult for mature age division 2 nurses – in other words, those who precede the introduction of the current diploma course – to access that top-up training in medication administration, and they clearly need that certification.

So, Minister, forgive my rather long prologue there, but could I just first of all indicate that Legalise Cannabis does have some concerns with the proposed statutory review five years down the track and we do envisage a very real possibility based on discussions with providers and staff that there may be issues. So could I ask you: can we get an operational review in a shorter timeframe than the five years proposed under the bill?

Ingrid STITT: Can I also just before I answer that particular question indicate that it is close to 30 per cent PSRAC beds in regional Victoria. So there are more in regional than there are in metro in terms of beds compared to the other parts of the sector. I think that is an important point to make.

The issue around the review of the reform has been the subject of a bit of discussion across the chamber, and I thank members for engaging with me and my office about this. The government is committing to a four-year review process of the reform, which will be informed by six-monthly insight surveys that will commence shortly following the passage of the bill, alongside other available data, information and insights. That is important because we want to get moving straightaway, not wait. The review will be completed by 1 July 2030, and the ongoing surveys will enable regular feedback on to what extent, for example, providers are complying with the reform and if there are any unintended consequences and opportunities for improvements. I certainly would give you this commitment that we are not going to wait for the end of the review period; if there are issues that arise, we will act to address them. The reason why we do not want to undertake a review that would finish any earlier than that is it will not allow sufficient time for those concurrent Commonwealth reforms to be fully implemented as well as time for education, ensuring providers understand their obligations, and to work through any necessary workforce changes. So this is a very similar approach that we took to the Aged Care Restrictive Practices Substitute Decision-maker Act 2024, which we dealt with last year here. So I can indicate that the government will agree to reducing the length of the review from five years to four years.

David ETTERSHANK: I am really appreciative of the discussions that have occurred with you at length and also with your office. Minister, my understanding and that of some colleagues is that the government was going to offer a three-year operational review. Could perhaps I get some clarification on that, please?

Ingrid STITT: I can certainly clarify, and we are absolutely on the same page here. It is just that my timing is to commence straightaway the collection of data and so on, so that is why I am calling it four years, but the conclusion of the review would be 1 July 2030. So it is the same outcome essentially, because the bill does not commence until 1 July 2026, but as I have indicated to many of you in conversations, the department will start the work on surveying the sector again to get that baseline data and to get those understandings early so that we can support them being ready for implementation. So I am kind of treating that as part of the review. I hope that makes sense and does not confuse things further, but we certainly have been open to the suggestions that have been made.

David ETTERSHANK: I think there might be some confusion as to that, so that is of some concern, but I am happy to discuss that further later. Can you advise the chamber who will be conducting that review, please?

Ingrid STITT: My department.

David ETTERSHANK: Obviously with all such reviews where they are not actually being undertaken through a public process, Minister, in terms of participation and transparency, could you advise us as to whether this review will provide public access to residents, providers, family members and the general public as part of that process and in an open and transparent manner?

Ingrid STITT: The review will be informed by consultation with residential aged care, with the sector broadly, including public and private providers, with unions and with sector peak bodies. I think I have already indicated that we would include six-monthly insight surveys that will commence shortly following the passage of the bill that will provide that key feedback mechanism directly to the department on implementation issues around the reform. I am committed to being transparent and working constructively with people, and I am committed to releasing the key findings of the review. At the end of the day, this is really about providing higher standards of care for residential aged care providers, so I am happy to give those commitments.

David ETTERSHANK: Sorry, forgive my lack of perspicacity in interpreting your comments, but will that process be advertised publicly as part of the engagement process with the public?

Ingrid STITT: It is not a public review. We want to get to the nub of making sure our services are ready and supported to enable them to implement these changes, so it is very much directed at the sector, but I think I take on the point that you are making around whether other people – outside providers and the workforce and so on, and the peak bodies and unions – can have input into the department process. I cannot see why not. I am not committing to some full-blown public review with all the bells and whistles, but I am not ruling out that there are opportunities for anyone with a keen interest in these reforms to have input through my department’s processes.

David ETTERSHANK: I draw some comfort from that that there will indeed be public transparency. There will be a public advertising and a calling for submissions to the review process. Am I correct there?

Ingrid STITT: It is not a public review, Mr Ettershank. It is a review that will be conducted by my department, but I am certainly open to everybody who has got an interest in having input into that review being able to do so unhindered.

David ETTERSHANK: I do not know that I actually get the unhindered bit, I am sorry. Could I just ask again: will this be publicly advertised to invite people to make submissions?

Ingrid STITT: It is a department-led review, so it is not the practice normally to do that, but I am not going to stop people who have a keen interest in these reforms having the opportunity to have input, whether they are directly connected to the sector or not.

David ETTERSHANK: I am sorry, I am having trouble, because there is obviously a bit of disconnect happening in terms of the discussions we have had with your office.

Ingrid STITT: I am happy to answer. I am advised, and I am sorry if this has been confusing, that regular reviews that are conducted by the department include an Engage Victoria process so that people can publicly submit their views. I am very sorry that there has been a misunderstanding. I do not have a problem with that in this instance.

David ETTERSHANK: We should work on dental soon – talk about pulling teeth. Thank you so much for that. I really appreciate that; that is terrific. Could I just confirm your earlier statement, which is that the report of the department arising from this process, the Engage Victoria process and suchlike, will actually be released publicly so people can understand what has happened and the government has got a true level of transparency over this process?

Ingrid STITT: As I indicated, Mr Ettershank, I am committed to releasing the key findings of the review and being transparent. I will put a caveat on that in that there will be some information contained within the review that the department undertakes that could be sensitive or confidential information from individual providers or individuals. I am not going to give a kind of blanket commitment around sensitive, confidential information, but I am committed to releasing the key findings of the review.

David ETTERSHANK: Again, forgive my slowness here, but when you say ‘key findings’, for many people in the public realm – and you understand this as well as or better than I do – often the outworkings of government are a bit of a mystery, or there is a desire to understand how people came to that conclusion. I know we are looking at some time into the future, and we probably need to clarify how far into the future, but can I clarify with you what people could legitimately expect by way of access to understanding what the department was thinking and why it came to those conclusions and how those key findings were arrived at? Would it be reasonable to assume that people could expect that there would be a narrative that provides that background information and provides the rationale as well as the findings?

Ingrid STITT: The issue I am feeling kind of sensitive around is I want to ensure that aged care providers are confident that any sensitive information that they provide to my department as part of this review is kept confidential and treated appropriately. That is where my reticence is in answering your question. But I think you have dealt with me enough now to know that this is not about trying to avoid transparency. It is in everybody’s interests for these reforms to work, and I am absolutely committed to making sure that the review is meaningful and that issues that emerge out of the review or may emerge out of the review are addressed and taken on by the government. I hope that gives you some confidence about my intentions around all this.

David ETTERSHANK: Just to clarify: excluding that sensitive or confidential information, as per my last question, there would be that narrative, that background, that rationale, as well as the key findings.

Ingrid STITT: There is not much use having findings without any context or any narrative, so I am fine with that. I just want to make sure that the sensitive nature of some of the information that might be gathered during the review period, bearing in mind there are going to be six-monthly surveys of the sector, is treated appropriately.

Georgie CROZIER: Just following on from that last point, what is the sensitive information that you are concerned about, Minister, given this is just around staffing and an ability to undertake what the legislation is asking to do? I do not know why you are so exercised about sensitive information in a review that might be undertaken to look at this in the interests of safety and for the absolute purposes of what this bill is trying to achieve. Can you elaborate a bit?

Ingrid STITT: Well, for example, any kind of sensitive information about residents’ health issues, medical records and the like. I am also mindful that providers who are not government providers or not public sector providers would be participating in this exercise on a voluntary basis, so I want to give them confidence that any data would be treated sensitively. It is no more than that, really.

Georgie CROZIER: I am a little bit curious about that. I mean, we do have independent agencies that undertake reviews of very sensitive material, and I think they do it in a way that provides that transparency to the public, so I just find that a bit extraordinary. I want to ask: has the government modelled the risk of any aged care providers needing to close beds or reduce their capacity due to the inability to meet those staffing requirements? Given that we know that in some areas of Victoria, there are numbers of carers that conduct a lot of this work, therefore what is the risk to areas, particularly in regional Victoria? As I said in my second-reading speech, you have got agencies where you can get staff in the metropolitan area very quickly, but you cannot in regional Victoria. So has the government identified areas in regional Victoria or done any modelling of where providers may need to close beds or reduce their admission capacity as a result of the staffing component that the legislation is looking to address?

Ingrid STITT: The department has, as I have kind of repeatedly gone to today, worked with the sector to develop the implementation approach to the reforms. That includes waiting for significant Commonwealth reforms to be implemented before commencing this new requirement on 1 July 2026. Some of the data indicates – for example, the StewartBrown data indicates that from 2025–26 the sector is expected to see fiscal improvements due to Commonwealth reforms that are aimed at improving the sustainability of residential aged care. That includes that additional funding that I went to earlier.

Georgie CROZIER: What is the data – the StewartBrown data?

Ingrid STITT: The StewartBrown Aged Care Financial Performance Survey Report from 2024 in September.

Georgie CROZIER: Is that public?

Ingrid STITT: Yes, that is publicly available.

Ingrid STITT: Yes, that is publicly available, that report. In addition, I have already mentioned the 90-day grace period where no enforcement action will be taken. That will give providers a lot more time, if you like, to get ready for the changes.

Sarah MANSFIELD: I have a couple of questions following up from Mr. Ettershank’s questions around the timing of the operational review. But at the outset I just wanted to thank you and your staff for your early engagement on this bill. It is very helpful. The dates you provided – if that review is to conclude in 2030, that is five years from now. We are in 2025 now, so if that concludes in 2030, that is five years from now but would be four years from the commencement of the bill. A three-year review period would be concluding in 2029. I want to clarify what the dates actually are.

Ingrid STITT: The government was originally suggesting that a five-year review be undertaken through the department. I have, in conversations with a number of members of the chamber today, agreed to reduce that to a four-year period, so the review would be completed and handed to me by 1 July 2030. That gives us – and this is important – enough time to start the work straight after the bill passes, should it pass, and then have that work completed in terms of getting the baseline data before the bill commences on 1 July 2026 and then do that work every six months, and obviously other work in between every six-month survey, to be able to deliver an informed piece of work to me by 1 July 2030, which reduces that time.

Sarah MANSFIELD: Thank you, Minister, for that clarification. There was probably an opportunity to reduce that timeframe, but I understand that you have got to sync with federal changes and other things. Given that that seems to be the earliest date you could conclude that review and have the report handed to you, what steps will you take along the way to address problems as they are identified and as they arise, and how will that be then publicly explained or relayed back to, at the very least, the sector?

Ingrid STITT: As I have indicated to a number of members in the chamber through conversations today and previous to today, we are very committed to if there is an issue that arises during the course of the review, that is a demonstration of the need for the government to act to support the sector in any way. If it is something that is impeding the good operation of these changes, then we will take action. My department wants to take a very proactive approach to supporting the sector with these changes so that they are able to be confident that the changes will not result in any adverse outcomes or any unintended consequences.

Sarah MANSFIELD: I am sure this has been touched on in different ways, but again, for some clarification, one of the biggest concerns that has been raised about this, and I know it is one you are familiar with, is that for some facilities just getting access to workforce is really difficult. It does not matter how much you pay them, they are just not locally available, and it is hard to attract people, especially to rural areas. What sort of practical support will be provided by your government to assist those facilities with fulfilling their requirements under the act if they have demonstrated they have done everything in their power to get an appropriately qualified nurse and are unable to meet those requirements?

Ingrid STITT: There are a number of ways that the department will support the sector. Some of that is within the review; some of that is just business as usual, supporting the sector to implement these changes. I think I have gone a number of times in committee today to the timelines and the time to prepare for the change. Communication is going to be critical in terms of providing webinars and other support material to ensure that there is clarity on the requirements. There will be further consultation around the regulations that will confirm the exemptions. The model of care exchange is something the department proposes. They want to host in-person forums to bring together government and non-government providers to share best practice in medication management and administration. This opportunity may assist in improving efficiencies and the quality and safety of medication management and assist providers in understanding and meeting the requirements of the reform. We have talked a lot about insights and surveys, so I will not repeat all of that educative enforcement approach. Then in terms of workforce supports that our government is providing across the health system, particularly focused on building a strong pipeline of nurses, there are a number of initiatives, including the free TAFE diploma of nursing, which is available under our free TAFE initiative, and the making it free to study nursing initiative, which has increased our nursing workforce. I have talked about the additional enterprise agreement outcomes and the Fair Work decisions that cover both the private and the not-for-profit sectors but also in respect to the nurses agreement that applies to aged care facilities in the public space. Our 2025–26 budget provides $95.1 million over four years to support Victoria’s health workforce through initiatives including registered undergraduate students of nursing transitional support programs and capacity development for rural nurses.

I think it is also worth noting that we are seeing increasing numbers of nurses graduating in Victoria, and that demonstrates that these investments are making a difference. Initial advice from health services indicates strong demand for graduate positions, including across our regional and rural placements. I know that there is more work to do in terms of the private and not-for-profit providers in aged care, but our efforts, combined with the Commonwealth reforms, I think are already making quite a big difference, as demonstrated by the fact that over 81 per cent of services already have a nurse administering medication.

Clause agreed to; clauses 2 to 10 agreed to.

New clause (17:29)

Georgie CROZIER: I move:

1. Insert the following New Clause to follow Clause 10 –

‘10A New section 36G inserted

After section 36F of the Principal Act insert –

“36G Review of operation of this Division as amended by the Drugs, Poisons and Controlled Substances Amendment (Medication Administration in Residential Aged Care) Act 2025

(1) The Minister must cause a review to be conducted of the operation of this Division as amended by the Drugs, Poisons and Controlled Substances Amendment (Medication Administration in Residential Aged Care) Act 2025.

(2) The review must be commenced after the second anniversary of the day on which the Drugs, Poisons and Controlled Substances Amendment (Medication Administration in Residential Aged Care) Act 2025 comes into operation.

(3) The person who undertakes the review must give the Minister a written report of the review.

(4) The Minister must cause a copy of a report of the review to be tabled before each House of the Parliament no later than the third anniversary of the day on which the Drugs, Poisons and Controlled Substances Amendment (Medication Administration in Residential Aged Care) Act 2025 comes into operation.”.’.

The reason for doing this is to have a review that is not the timeline that the government has outlined through the second-reading speech, the summing up and the committee stage. I still do have concerns around a number of things. The data not being provided, including the 82 per cent of nurses who are said to be administering medications – we do not have that data. Where does it come from? We still do not have the information around the surveys from the 770 providers and how many of those were undertaken in recent years and previously. I do think we need to have a proper review into this very significant issue, given the work of the royal commission, given the work of the federal government, and then ensure that this legislation that we are debating today is actually doing what it is intended to do. That is why I am saying that there should be a review in two years from next year – from the commencement of this bill, 1 July 2026 – which would effectively be three years of work if the department started that work in terms of gathering that data now. I think that is enough time for the department to get that data and provide it into a review process that then determines whether actually this legislation is achieving what it should be.

There are concerns from the sector, from stakeholders and from a number of providers around the issue of workforce and how they will meet the government’s requirements. There are still too many doubts from those stakeholders that I have spoken to around really the expectations, and they want to get it right too. That is why I say the initial review of five years, which would have taken it out to 2031, was way too far away and gave no certainty or clarity to the sector. There have been a number of discussions with the crossbench, and Mr Ettershank has done a great job in getting the government to somewhat move. However, I do think that we need to get this right, and I do think that it needs to be an independent review. The department, providers and stakeholders can provide the data to see that this bill is actually doing what it is intended to do.

Ingrid STITT: The government will not be supporting Ms Crozier’s amendment. To clarify the government’s position on this, the government is committing to a four-year review process of the reform, which will be informed by six-monthly insight surveys and will commence shortly following passage of the bill, before the end of 2025, alongside other available data, information and insights. This review will be completed by 1 July 2030. The ongoing survey will enable regular feedback on the extent to which providers are complying with the reform, any unintended consequences and opportunities for improvements. An earlier review will not allow sufficient time for concurrent Commonwealth reforms to be fully implemented as well as time for educating, ensuring providers understand their obligations, and to work through any necessary workforce changes. Similar to the Aged Care Restrictive Practices Substitute Decision-maker Act 2024, this is not proposed to be a legislated review but a departmental review that will be provided to me as the minister.

David LIMBRICK: The Libertarian Party will not be supporting this amendment either. I am concerned about having this review before, as the minister indicated, the federal reforms are actually implemented. I think it should be done as soon as possible, but I do not really see the point in doing it before the federal reforms are implemented; therefore I will not support this.

Council divided on new clause:

Ayes (15): Melina Bath, Gaelle Broad, Georgie Crozier, David Davis, Moira Deeming, Renee Heath, Ann-Marie Hermans, Wendy Lovell, Trung Luu, Bev McArthur, Joe McCracken, Nick McGowan, Evan Mulholland, Rikkie-Lee Tyrrell, Richard Welch

Noes (23): Ryan Batchelor, John Berger, Lizzie Blandthorn, Katherine Copsey, Enver Erdogan, Jacinta Ermacora, David Ettershank, Michael Galea, Anasina Gray-Barberio, Shaun Leane, David Limbrick, Sarah Mansfield, Tom McIntosh, Rachel Payne, Aiv Puglielli, Georgie Purcell, Harriet Shing, Ingrid Stitt, Jaclyn Symes, Lee Tarlamis, Sonja Terpstra, Gayle Tierney, Sheena Watt

New clause negatived.

Clauses 11 and 12 agreed to.

Reported to house without amendment.

Ingrid STITT (Western Metropolitan – Minister for Mental Health, Minister for Ageing, Minister for Multicultural Affairs) (17:41): I move:

That the report be now adopted.

Motion agreed to.

Report adopted.

Third reading

Ingrid STITT (Western Metropolitan – Minister for Mental Health, Minister for Ageing, Minister for Multicultural Affairs) (17:41): I move:

That the bill be now read a third time.

Motion agreed to.

Read third time.

The DEPUTY PRESIDENT: Pursuant to standing order 14.28, the bill will be returned to the Assembly with a message informing them that the Council have agreed to the bill without amendment.