Tuesday, 25 August 2026

 Georgie CROZIER (Southern Metropolitan) (14:33): I am very pleased to rise and speak to the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2026. As a former nurse and midwife myself, I am always very pleased to be speaking to these bills when I can and to also, when we get these bills, understand the intentions of the government. I want to just say a few things around this bill and those that I have spoken to. Before I go to this bill, the bill essentially amends the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 to categorise or recategorise hospitals for the purposes of nurse-to-patient and midwife-to-patient ratios, and it recategorises some hospitals at a higher level and categorises additional hospitals in schedules 1 and 3 of the principal act. That is important in relation to some of my colleagues who are in regional parts of Victoria where many of these recategorisations will have an impact and what it will mean to them. They are being put into those schedules, and therefore the nurse-to-patient ratios in those areas and specifically in those hospitals will have an impact, and also to areas around emergency departments and intensive care and the like.

I want to just place on record I have been around the state over the last few weeks, or few months, since we have been here, speaking to a whole range of clinicians, administrators, people within hospital boards and, importantly, patients, and they have been telling me the impacts of what is going on. I just moved a motion in the house around a Ballarat nurse who has written an open letter, very distressingly. This bill impacts exactly this very issue, because that nurse, who was a nurse at a busy regional hospital, the Ballarat Base Hospital, part of Grampians Health, was saying, in her words, the ‘caring was destroying me’, while she and fellow nurses felt abandoned and unheard. I do think that is really concerning, given these are the frontline nurses that do the work on behalf of the community and do an extraordinary job. We know that there is burnout and we know that staff are feeling under pressure and are not feeling supported, and part of what the government is trying to do with this bill is to provide that support and to put ratios in place to enable that to occur.

I will go back and just talk a little bit about the history before I get into this. In 2015 the then Andrews government introduced the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 to enshrine in law the minimum staffing levels for nurses and midwives in the Victorian public health system, and at the time the then shadow minister Mary Wooldridge was very clear about our support of those intentions. Those ratios were previously part of the nurses and midwives enterprise agreement, and since that time there has been a tranche of legislation that has been brought into the Parliament that has dealt with a number of areas around the patient ratios. That included ratios in specific settings, including stroke, haematology and oncology wards, palliative care, aged care, birthing suites and emergency departments. As I said, ratios apply to hospitals across the state according to classifications as levels 1 to 4 as listed in the act’s schedules, which I referred to earlier.

I was just reflecting on the debate, and at one point there was criticism around what had gone on. But in the 2018 tranche of legislation there was a real gap, and nurses and midwives that work in special care nurseries were not included in the bill. It was flawed, and I went back and had a look at what I said at the time and what Ms Wooldridge said at the time too. She was very clear:

Can I say at the outset that the Liberal–Nationals are not opposing this bill.

The bill did not proceed in 2018 and had to come back in 2019. There was quite a kerfuffle, and the government carried on and made a big deal out of it. So did others. It was completely unnecessary, because the government had stuffed up on the bill. When it came back in 2019 and we were debating it, I said at the time:

So I am very pleased that that flawed bill from the last Parliament has been rectified and that those midwives – those excellent midwives that provide the care in special care nurseries – are now recognised …

I said it then and I say it again now, because I know what those nurses and midwives do in special care nurseries. I worked at the Women’s Hospital for 10 years and know the amazing work that they do providing care in very difficult times and sometimes over very extended periods of time. That bill was flawed in its design, and the government corrected that and we debated that in 2019. I put it on record because I think there are some that just do not really understand the facts about what went on, and I would hope that they would not try to misrepresent actually what had gone on at the time.

This bill, as I said, implements the review that the government undertook into hospital classification, which then went to assess a hospital’s workload and determine its staffing requirements. The review applied algorithms using health services’ public datasets to reclassify hospitals based on their capacity and also patient complexity. I think that is very important to say, because with the mix of patient complexity, the mix of staffing that needs to be in place to support that patient complexity is incredibly important. It is why I raised, at the outset of the debate, the nurse that wrote that open letter to say how she and others felt abandoned and unheard, given the complexity and demands that are in our current health system. I want to say that it is a very different time from when I was nursing or when I was working at the Women’s as a midwife and running a specialist clinic there – a very different time. The volumes are much greater. The complexity is much greater. With COVID and our increasing and ageing population – when people did not get screened and they did not have their elective surgeries – they were always going to get sicker. I said that at the time, and I maintain it. Bad government decisions have contributed to a lot of complexity that is being seen now.

The bill does raise a few issues, and I will tease some of this out during the committee stage. I did ask this in the briefing. Just as in the previous ratio-amending legislation, it is unclear if the allocated funding will be sufficient to meet the high costs of employing more casual agency nurses if hospitals are unable to recruit permanent staff. It is my understanding that the government has allocated $109.7 million for these changes and it will add 253 full-time equivalent positions within the public health system. The last lot of legislation allocated a funding boost of I think $270 million. I would like to understand a little bit more around the numbers that this equated to, because it was unclear to me with the answer that I got back. The department said, ‘Yes, we’ve implemented it,’ but it is not telling me exactly how many staff were put in place. Did it meet those requirements that the government said it would?

One of the other issues that has come to my attention is we do not have any real information on how well hospitals, especially in regional Victoria, are managing the current requirements legislated last year. We know that in some circumstances some hospitals can get exemptions. As I said, when I was asking this during the briefing the written response that I received was:

100% implementation of the April 2025 legislative amendments came into effect on 1 July 2026.

Data post 1 July 2026 is not yet available.

But that is not my point. I was asking, ‘Have you been able to fulfil what you promised to do through the legislation of last year in providing the staffing arrangements that are needed?’

I want to go to the various feedback that I have received from stakeholders, and I thank them very much for providing their feedback. The Australian Nursing and Midwifery Federation, quite rightly and correctly, say:

The bill is the result of years of advocacy by ANMF nursing and midwifery members, particularly members in regional Victoria.

I am interested in that point. That is very true; they have been big proponents of these ratios. They go on to say:

It is backed by data. All proposed changes to the hospital level (Schedule 1 of the Act) or ED level (Schedule 3 of the Act) are based on a review of the Department of Health data. These levels in the Act determine the ratios in general medical/surgical wards, ICUs and emergency departments.

They also say:

The improved ratios will … provide an opportunity for additional graduate nursing positions across these hospitals …

While I am speaking about that, 1500-plus graduate nurses cannot get a job in this state. As I said at the outset, it is the complexity of the patient but also the experience of the staff which are very, very important to be able to manage what a hospital, a ward, an emergency department or an intensive care unit requires. It is not just about numbers going into those areas; it is about the skill set, the experience and the ability for those nurses to actually do the work in those very complex areas. I am pleased if there is opportunity for graduate nurses, but you cannot have all junior nurses coming into a system where you have got senior nurses leaving without that ability to mentor, support and supervise and provide, give and pass on their knowledge and expertise in this area. I know from my own experience how important it was for senior nurses to be there to impart their knowledge and to be there as a backup for you while you are dealing with some very difficult, challenging and complex times – sometimes extremely challenging. When you have got multiple things occurring at one time, you have to be able to allocate and understand the priorities of the care that you need to deliver, and that comes with experience and an understanding of the complexity of the patient, of the surrounds and of the environment that you are working in so you can determine the decision that you are making. That comes through that experience and leadership of senior nurses, and I am worried about that level. It is not just about numbers; people have got to recognise the complexity, and that is why I am interested in the data and interested in what that mix is.

The Australian College of Nursing provided some excellent feedback on the bill, and I thank them. They also raised this very issue I have been speaking about, around the number of nursing graduates completing their studies and becoming eligible for registration at the end of 2025. They spoke about the number, and they said to me:

ACN is aware that the 2026 cohort of nursing graduates is likely to be larger than that of 2025 …

That is 1500 graduates, as I mentioned.

This highlights a critical disconnect between workforce demand and workforce planning, particularly in light of reductions in investment in transition-to-practice programs for newly qualified nurses in Victoria.

They went on to say that the additional funding may be needed to meet the higher costs of employing more casual agency nurses. Legislated ratios combined with workforce shortages increase reliance on agency nurses, which can impact hospital budgets and also affect continuity of care.

I have been an agency nurse. I worked as an agency nurse for a short period. You are put into situations which you are not familiar with, so it takes longer for you to familiarise yourself with procedures, understand the patient background and all of those things. That is a very legitimate concern that the ACN raises around the impact on continuity of care and also the constraints on hospital budgets. There are hospitals and health services in this state that are in deficit – so they tell me. The government might say what they like, but they are under enormous pressures. When you have got these legislative requirements coming in – and I note that this is not going to be in place until 2029, I think – to make way for where these specialist areas are going, where these nurses are required, there is a huge demand on hospital budgets and the administrators and executives who are looking at those budgets and trying to work within the parameters that they have been provided. Those constraints that they are currently under could have an impact on things on such as planned surgery and emergency department capacity. We have seen reports this week that Royal Melbourne are turning away patients. They are not taking patients. They are dictating who they are taking, and that is a very significant issue that I am very concerned about.

The ACN obviously supports the bill’s intent and the important benefits of ratios for nurses and patients yet notes that the effectiveness of ratios is dependent on the availability of a sustainable workforce. They highlight the disconnect between workforce demand and workforce planning, which may compromise the ability to deliver these legislative changes after the transition period. I think that is an important note that the ACN has picked up on. They are supportive, as we are, but how it is done, what is in the system now and what is happening in the system are very important to understand.

The Australian College of Critical Care Nurses also provided feedback. They also support stronger staffing ratios, but they warn that Victoria may not have enough specialist critical care nurses to safely meet the new requirements, particularly in regional hospitals and senior ICU roles. That goes back to my original point around the intention. No-one is disagreeing, but can it be delivered, especially in those regional areas where we know there are workforce shortages? There are gaps in these areas for clinicians at very senior levels, whether it is doctors or nurses. These are critical areas, like emergency departments and intensive care. You cannot just walk off the street as a newly branded nurse and be expected to manage a patient in an ICU or an emergency department competently. You need to have that experience, that time in the system, which gives you confidence and provides you with an ability to learn and grow and impart that experience as you work. The ACCCN also raised concerns about Victoria’s current education and training capacity to develop the specialist workforce that may be required, including postgraduate, critical and nursing education, transition to specialty programs, clinical education positions and development pathways that enable experienced ICU nurses to progress into senior clinical and leadership roles – exactly what I have been talking about and discussing. It is very important that people understand how those transition programs actually do work and the impacts if they are not carried out or if they are not implemented appropriately.

There is no question that the Liberals and Nationals absolutely support the intent of this bill. We do not oppose this bill, but we have these concerns, and I will get clarity from the minister through the committee stage around some of these issues. We all want our nurses and midwives to be supported, to be safe and to be able to care for the patients that they are caring for, not to feel abandoned and not to feel unheard, like the Ballarat nurse who wrote her open letter. I mean, that was just a stunning plea, if you like. Somebody has been driven to that extent because of months and years of feeling under so much pressure. That is what we have got to stop. That is why we need to support our nurses and midwives in the incredibly important roles that they undertake.

I was so pleased, actually – the other day I was walking to a stakeholder meeting down here in Albert Street, and there were three women in the middle of the road calling out to me, and they had all come from St Vincent’s. One of them said to me, ‘I worked with you at the women’s hospital,’ and they were just terrific. They were talking about their work. They loved their work. They were such great nurses and midwives, and one of them was in a senior role, I think. It was so fabulous to hear these nurses reach out to me in the middle of Melbourne. I could not remember working with one of them, but we did recount some stories at the time, and they are happy memories. That is what I would hope for all our nurses and midwives, to have those happy memories, because it is a fantastic vocation. To those graduates that are coming through, I say stick with it, because it is important that you do have the ability to follow through what you have learned through the vocation that you have chosen. There are some fabulous men and women out there who are doing so much for the Victorian community, and if we can provide greater support and understand what the challenges are and work towards fixing those, then we will go a long way to providing exceptional care, which we are all striving to do.

I am concerned, however, that there is so much pressure on the system at the moment, whether it is budgets or whether it is other things, like, as I referred to, the Ballarat nurse who left the system because she just could not do it any longer. She said, ‘Caring was destroying me.’ That is the last thing anyone wants to hear. I am sure those around her will be providing her support, but it is very unfortunate that a nurse has had to go to the length of writing an open letter to say that is the pressure they are under. She is not on her own. There are others that are saying, ‘We feel unheard and unsupported.’ I hear that too. I have nurses that contact me all the time about the challenges that they are under, and we do need to be supporting them. If this legislation goes some way to doing that in those areas – and this the final tranche of implementing what the government set out to do – then that is a good thing. But I will be raising questions in the committee stage to understand a little bit further what the government is going to do to alleviate some of these pressures.

 Sonja TERPSTRA (North-Eastern Metropolitan) (14:56): I rise to make a contribution in support of the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2026. Before I get into the detail, I want to acknowledge the strong advocacy and hard work by the Australian Nursing and Midwifery Federation (ANMF) Victorian branch. I want to acknowledge in the gallery some colleagues today: assistant secretaries Sam Casey and Nicole Allan and also secretary Maddy Harradence. I can also reflect on my time at the nurses union working with Paul Gilbert and Lisa Fitzpatrick in regard to the very first bill that came to the Parliament that enshrined nurse-to-patient ratios in law. Might I say that when the Victorian Parliament introduced the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 – when Victorian Labor introduced that – we were only the second jurisdiction in the world to legislate nurse-to-patient ratios. That was a promise that we kept, and I am really pleased to be here today speaking in this chamber again about extending and expanding nurse-to-patient care ratios, because they are important and we know they work. I am going to talk a bit in a minute about why they work and why they are so important.

They are important from a workforce perspective but also from a clinical perspective. They deliver better patient outcomes. There is a lot of detail about this, and I know that there are lots of different angles to this as well; it is not just one-dimensional. I was just reading some of the detail about this in the ANMF journalfrom July 2024 that talks about some of this. For example, we have as a result of these reforms clinical outcomes and patient safety outcomes that reduce patient mortality. There is broader health services research that evaluates that the change in nursing ratios demonstrates a direct inverse relationship between higher nurse staffing levels and in-hospital mortality. The studies on mandating staffing thresholds show that ensuring that nurses handle no more than four patients on acute day shifts significantly reduces the risk of preventable inpatient deaths. That can only be seen in one way, and that is as very good news. It is very good news for the care that gets delivered in our public hospitals and it is also good news for patients and their families – they can have confidence in our public health system and know that through these ratios they are getting the very best care that can be provided in our public health system.

What has also been highlighted by these reforms is that there are mandated ratios that correlate with measurable drops in failure-to-rescue events: nosocomial infections, medical errors and pressure injuries. Sufficient staffing ensures timely monitoring, enabling early detection and clinical intervention when a patient’s condition deteriorates. Again, as we know, by making sure that these ratios are in place we know that our nurses have more time to provide excellent care, so we can see that these things are being documented and being studied as well. Also, importantly, lower readmission rates and shorter lengths of stay – nobody goes to a hospital by choice. But of course we need to when we are very sick, and when we go there, what we are seeing is that the implementation of ratios demonstrates a net reduction in average length of stay and fewer unplanned 30-day readmissions. This alleviates the ongoing burden of higher acuity cases needing readmission to hospitals. Now we have this increased care, it is much better. We are seeing fewer 30-day readmissions, so again it is better for patients and better for hospitals.

I might just add that on the workforce aspects these nurse-to-patient ratio changes will see an additional 253 full-time equivalent nursing positions added to the system, and this is backed by a $109.7 million investment in our public health system. The legislation will reclassify 26 hospitals, including 17 in rural and regional Victoria, to a higher level. I was pleased to see, while sitting here researching and looking at the notes and information, that Maroondah Hospital is one of those ones that is going to be reclassified. It is a very important hospital in my region. It is a very busy hospital in my region. It has lots of different acuities there. I was just there the other day. We were talking about the newly announced stage 1 redevelopment rebuild of Maroondah Hospital, which is the paediatric ED. We are seeing lots more children being admitted to the ED, and it is a good thing that our government invests in ensuring that Maroondah Hospital will have a dedicated paediatric ED. Having little kids in emergency departments is not such a good thing – it is a very busy and very stressful environment – so if we provide a quieter space for children to be admitted it is much better for them as well.

I just might quickly go through some of the hospitals that have been listed: Maryborough hospital, Maroondah Hospital, Mercy women, Royal Women’s Hospital, Werribee Mercy – these are some of the busiest hospitals in our public health network – Angliss, Rosebud, the Royal Victorian Eye and Ear Hospital, Victorian Heart Hospital, Sandringham, Ballarat Base, Bendigo Health, Latrobe Regional, Shepparton, Bairnsdale, Echuca, Sale, Swan Hill, West Gippsland, Wimmera, Wodonga, Wonthaggi, Ararat, Colac, Wangaratta and Hamilton. As you can see, many rural and regional hospitals will stand to benefit from these additional ratios. As I said earlier, what we know is that means that there will be better patient care, better patient outcomes and reduced readmission rates as a result of these ratios.

I will not go into great detail because I know we have got to be efficient today in our contributions, apparently, because we want to get through the day and not be here till 3 o’clock in the morning, but nevertheless one of the other things that we know as a result of workforce stability and continuity of care is that these ratios also mean better nurse retention and recruitment, because the pressures that our hardworking nurses are under are just crippling. It is a very busy, very challenging environment and our nurses do a fabulous job, but what we seeing is that there is an improvement in nurse retention and recruitment and also, importantly, a reduction in burnout and missed care. Those things are really important. When you are tired and burnt out because you have been going from shift to shift to shift and dealing with patients with very high acuity and just racing, it is very difficult. These ratios mean that we will see a reduction in the burnout and the missed care, so again, it is very, very critically important.

I could go on and on. There is lots to talk about on this. But also, importantly, in terms of ongoing policy refinement – and I remember talking about this with my colleagues when I was at the nurses union; we always talked about things like skill mix management – it is really important that we make sure that where we have nurses, and this is something Ms Crozier talked about, there is a consideration around that. Obviously when you have got a shift of nurses, you need to make sure they have got the right skill mix, that people are being supervised properly and also that those nurses are learning on the job, if they are new graduates and the like. There are a range of things that look to cover those sorts of aspects as well.

As we know, the investment in our nurse-to-patient ratios and the extension and expansion of them will also mean that additional roles will create more opportunities for graduate and early career nurses. We have delivered a huge pay increase, and full credit to the nurses union for bargaining for that 28.4 per cent pay rise. That means our nurses were fully recognised in that pay increase as well, because they work very, very hard, and we know the challenges that they all experienced during COVID as well. With that pay increase, clearly the members were very strong in their view about making sure they were recognised in that bargaining agreement, and they won a significant pay increase. But also there is the advocacy, as I said before, of the ANMF and their pursuit of ensuring these nurse-to-patient ratios are fully delivered and what this will also mean for nurse-to-patient ratios across Victoria.

I want to talk about some of the detail: in ICUs the gold standard of one-to-one nurse-to-patient ratios on all shifts for level 1 and 2 hospitals, as well as team leader and liaison nurses; in emergency departments improving staff ratios in resuscitation cubicles on morning shifts in line with afternoon and night shifts; in maternity services safer one-to-four midwife-to-patient ratios in postnatal and antenatal wards on night shift, down from one-to-six; and in high dependency and coronary care units the introduction of an in-charge nurse overnight. Again, this is critically important. You can see the detail about how this is going to be delivered and the rollout of it.

Also, the Victorian government will continue to support workforce recruitment and retention and professional development in regional and rural areas, and here is some of the detail around that. The rural urgent care nurses capability development program supports registered nurses working in urgent care centres in rural and regional Victoria to provide safe, high-quality care. In 2024–25, 349 nurses were supported through online learning modules, face-to-face workshops and clinical placements, and the Maternity Connect Program supports midwives and nurses working in rural and regional health services to maintain their skills by providing short-term clinical placements in larger regional or metropolitan maternity health services, supporting them with their professional development and skill improvement. So there is scaffolding and infrastructure around this legislation, and you can see I have gone to some of the detail about how we are going to ensure that the skill mix will be met and how the appropriate staffing will be attended to. I will leave my comments there because, as I said, we have been told we need to be efficient today with our contributions, but I commend the bill to the house.

 Gaelle BROAD (Northern Victoria) (15:07): I am pleased to be able to contribute to the discussion that we are having in the chamber today about the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2026. In 2015 the government moved to enshrine in law the minimum staffing levels for nurses and midwives in the Victorian public health system, and this amendment seeks to update the existing classifications of 26 hospitals, including 17 in rural and regional areas. Health care in rural and regional areas is not always that easy to come by. I was speaking with a lady today from Harrietville whose husband had severely injured his knee, and she had to go to Wangaratta. They could not get an X-ray there and could not get an MRI. They then had to go to Bright, where they got an X-ray, and ended up having to go to Albury Wodonga Health, which was a 2-hour drive. A 7 am surgery was locked in, which meant overnight accommodation the night before. But this is the challenge that is occurring in our regional areas when it comes to health care, and recent news reports show that there have been over 3300 patients admitted to emergency that stayed over 24 hours. Seventy per cent of those were from rural and regional hospitals, and that includes in Bendigo, which is where my office is located, and I live in that community.

The Victorian Auditor-General’s report from 2024 shows that over the last decade there has been a significant increase in the number of patients that are having to stay 24 hours or more. That is incredible pressure on staff and those are not very good outcomes for patients. I have spoken with a number of people who have been in contact with me who have raised concerns about being left in a wheelchair, being left in a corridor, waiting for support or going to the emergency services and not being able to get it. I have also heard from many – and I have spoken about it in this chamber – about the lack of ambulance services being made available and even taxis not being available and families finding the very difficult circumstance of having to get their loved one at a traumatic time to the hospital. I have heard from nurses in response to this bill, and they have indicated to me that the hospital emergency department presentation and hospital admission data has been collected for all our Victorian public hospitals and that it has been recognised for some time that the current classification system does not reflect the increased demand we are seeing in our public hospitals.

As has been mentioned, the changes in this bill come into operation at different times for general wards, emergency departments and intensive care units. Changes to general ward ratios for hospitals in schedule 1 commence on 1 July 2027. From that date, hospitals that have been recategorised or are newly included must comply with the nurse-to-patient and midwife-to-patient ratios that apply to their new level. Schedule 1 changes – the hospitals upgraded to level 1 – include Bendigo Hospital, which is in the Northern Victoria electorate. Hospitals classified as level 2 include Albury Wodonga Health’s Wodonga campus, Echuca Regional Health and Swan Hill District Health, which are all in Northern Victoria as well. I note that for the hospitals upgraded from level 2 to level 1, the ICU staffing requirements that apply to level 1 hospitals will not apply until 1 July 2029 under these transitional arrangements. I know that certainly with the emergency department wait times that we are seeing that is a significant concern.

I understand it is complex, and I really appreciate the work of Ms Crozier in this space. It is so beneficial to have someone with experience of working in the sector. I know this from my own family. I have got an aunty that was a nurse. She is now retired, but she spent her whole career as a nurse and with training, and it was very beneficial to have her insights. Now my own daughter is studying nursing, so I hope that she will be able to help contribute in future, because we know that we really need to support those people that are undertaking training. Ms Crozier has undertaken a lot of consultation and received feedback from the Australian Nursing and Midwifery Federation, the Australian College of Nursing and the Australian College of Critical Care Nurses, and there have been a number of concerns raised. Just as we have had with previous legislation that has come through this chamber over the years that has been about amending the legislation, it is unclear if the allocated funding will be sufficient to meet the higher costs of employing more casual agency nurses in hospitals that are unable to recruit permanent staff. I know from speaking with people that that is a very expensive way of trying to retain staff numbers. The department staff were asked in the bill briefing if all hospitals are meeting the current ratios, which commenced in full on 1 July 2026. It was taken on notice, but at the time of this bill report it had not yet been responded to. The Australian College of Nursing acknowledged the important benefits of ratios for nurses and patients but noted the effectiveness of ratios is dependent on the availability of a sustainable workforce.

I know this from the feedback that I have had from nurses in the community. I will quote them, because it is very beneficial to hear from them directly:

In my 25 years nursing, I have seen increased demand for health care and increased acuity of patients with added complexity to the Nursing role. Part of our nursing role is to support our nursing students, graduates and less experienced nurses. The evenings are at a time when less staff are working to provide support to these nurses, and having the improved ratios would definitely help to give these staff the adequate mentoring and support they need early in their career, which in turn, helps retain them in the system and keep patients safe.

There are many Government targets our hospital strives to achieve, and the pressure to meet these is filtered down to our wards. With the high patient turnover and acuity, it often feels like a rush against the clock to get everything done, and at times things are missed because we simply don’t have the time in the day to do all we would like, and all our patients deserve. For some staff this leads to increased personal leave, burnout, or moving to other less demanding areas. Improved evening ratios I could see would alleviate some of this pressure, and would result in improved care to our patients.

Another nurse wrote to me about this legislation. I think it is very important to share this insight, because I have heard this is happening. The situations and the threats that nurses are facing now when they go to work are appalling. Her correspondence to me stated:

Nurses are being assaulted, and nurses are leaving bedside nursing because of it. Weekly a friend tells me of a job they’ve applied for outside of the hospital. More nurses are dropping to casual so they can decide when they want to be present on the ward.

I was punched in the face by a patient when I was six weeks pregnant. Just last week, a nurse friend of mine was slapped in the face by a different patient. Those incidents were approximately a year apart, yet despite the constant occupational health and safety meetings our hospital holds, there has been no meaningful change in that time.

She went on to say:

Last year, we had two patients with dementia become physically aggressive towards each other in our hospital hallway. It was young female nurses who were left standing between them, frightened, while we waited for hospital security to arrive. When you have two physically capable, violent men standing metres apart, those few minutes feel like an eternity.

These situations are becoming one of the things nurses are most frustrated and fed up with. Not because we don’t want to care for these patients, we do, but because we are being asked to manage increasingly complex and sometimes dangerous behaviour without the resources or appropriate environment to do it safely.

They went on to say:

Improved ratios are absolutely part of the answer, and the reclassification bill is an important step. But improved ratios are just the start.

The state election is fast approaching, and regional health care is just such an important topic to so many people that I speak to in our community. We are committed to upgrading hospitals and health facilities – Mildura base hospital is one of them, and I know Jade Benham has been a very passionate advocate for that – but also to getting the healthcare workers where they are needed. I hear so often about the lack of accommodation. I know in Swan Hill that has certainly been a big issue. There are jobs there, but it is the housing that can hold people back. We are also committed to abolishing Labor’s GP tax so practices can bulk-bill more patients and keep fees lower, making it more affordable to see your local doctor, because that is so important. It is important for us to make sure particularly that regional and rural services stay viable. We are committed to delivering the 2021 mental health reforms in full. Victorians were promised all 74 recommendations from the 2021 Royal Commission into Victoria’s Mental Health System, yet five years on regional Victorians are still waiting for the local community-based care they were promised.

Just recently I met with a number of nurses in my office, and they were telling me about plans. They are part of the Bendigo Base Hospital Trained Nurses’ League, and they were fundraising to construct a statue that was to be locally sculpted. They were raising funds to recognise 106 years of service. Speaking with those nurses and the wealth of information that they had in the room and the experience that they had across working in different parts of nursing, they were so passionate about their career and so grateful for being able to look after patients and contribute to their care. Of the thousands of nurses that I know that have been trained at Bendigo, they have gone on to work across regional Victoria, across our state, interstate and also overseas. I was delighted to hear recently that they were successful in raising the funds that they needed to construct that statue, and it is going to be launched in 2027. For Jenny Trewartha, the president of the Bendigo Base Hospital Trained Nurses’ League, and all her companions, I just want to acknowledge their work, not just in their careers as nurses, but being able to look forward to that statue being unveiled and the recognition that that will give to the many thousands of nurses that have contributed to our health system.

We certainly, as Ms Crozier has indicated, are not opposing this bill. We want to support the staff, and we also are so desperate to see improved outcomes for patients at times when they desperately need our support.

 Jacinta ERMACORA (Western Victoria) (15:20): I am pleased to contribute on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2026. This bill will change how hospitals are categorised via the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015. It will recategorise 26 hospitals to a higher level for the purposes of required nurse-to-patient and midwife-to-patient ratios, and this means that they must roster more nurses for the same number of patients, improving staffing and patient care. We know that higher ratios increase patient safety and improve patient outcomes – I think we have had agreement on that across the chamber – and we know that they also make safer and more manageable workplace environments for our nurses, who bring extraordinary expertise and commitment to their increasingly complex jobs. It is a fact that seems to be lost sometimes, historically, by those opposite.

Let us take a look at the historical record. This bill is the latest in a long history of Labor governments backing our nurses and prioritising the safety of Victorians. The story of nurse-to-patient ratios in Victoria starts with the damage done during the 1990s under Jeff Kennett’s Liberal government. Seventeen public hospitals were closed and thousands of hospital beds were closed. It was by any measure a hollowing out of Victoria’s public health system, and it fell hard on regional communities, with hospitals in towns like Koroit, Mortlake and Macarthur closed down. When Steve Bracks was elected in 1999, rebuilding the nursing workforce was a priority. In 2000 Victoria became the first jurisdiction in Australia and one of the first in the world to mandate nurse-to-patient ratios. These ratios were contained in the nurses enterprise agreement but not in legislation, and as soon as the Liberals returned to office they tried to remove them or undermine them. Then opposition health spokesperson David Davis had written to the nurses union promising to maintain nurse-to-patient ratios in their current form ahead of the 2010 election. Seven months into government, that promise was broken. A leaked cabinet document signed by Davis in May 2011 revealed the Baillieu government’s actual plan. They planned to cut the number of nurses and midwives; to put the safety of Victorians at risk, with fewer and less qualified healthcare staff; to attack our hardworking nurses and midwives with worse working conditions; and to push the dispute into arbitration, effectively a backdoor way to make ratios disappear altogether.

Ahead of the 2014 election Daniel Andrews made a commitment that a Labor government would legislate ratios so nurses would never again have to strike to defend safe staffing levels, and that is what they did. On 23 December 2015 the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 was proclaimed. Victoria became the first jurisdiction in Australia to legislate minimum nurse-to-patient ratios in public hospitals, and over the next few years we set about specific ratios for stroke, haematology and oncology wards. Just last year our government invested over $100 million in delivering the one-to-one gold standard ratio in ICUs around the clock and improved emergency department resuscitation staffing, and we brought in a safer one-to-four midwife ratio overnight in maternity wards and an in-charge nurse overnight in high-dependency and coronary care units. These changes came into full effect on 1 July this year. There is a bit of a pattern here. Labor governments introduce the ratios and protect them and Liberal governments try to take them away, which undermines Victorians’ health and makes lives worse.

The reforms in this bill are important for the safety of all Victorians but particularly those in regional and rural areas. Of the 26 hospitals across Victoria that will move up a level, 17 of them are in rural and regional Victoria. In my electorate, Ballarat Base Hospital moves from level 2 to level 1 – that is the highest classification in the act – Grampians Health Wimmera Base Hospital in Horsham moves from level 3 to level 2, Ararat hospital and Colac Area Health both move from level 4 to level 3 and Hamilton Base Hospital will have a legislated minimum staffing ratio for its emergency department. Warrnambool Base Hospital was reclassified as a level 2 hospital in 2022, reflecting the number and complexity of matters that the expert staff there manage. Our community has felt the benefit ever since: more nurses at South West Healthcare, safer staffing in our wards and our emergency department and better outcomes for patients right across the south-west. Warrnambool shows us what is coming for Ballarat, Horsham, Ararat, Colac, Hamilton and beyond.

Ratios on paper are not enough. We need the workforce to fill them, and that has certainly been described in this debate as a problem. But we have that covered as well. It is harder in rural and regional Victoria to cover new positions. We are continuing the $270 million Making It Free to Study Nursing and Midwifery initiative, and it will support 17,000 nurses and midwives. This year’s budget included $26 million to boost the graduate nursing and midwifery program, and that is 250 more graduate positions. For rural and regional services specifically, the rural urgent care nursing capability development program supported 349 nurses last year through online learning workshops and clinical placements. The Maternity Connect Program gives rural midwives and nurses short placements in bigger maternity services so they can build their skills without leaving their community. This is really vital because it allows qualified midwives to work in smaller hospitals where there are not as many births per year. They may not reach their number of births or deliveries per year if they stay there, so they go to a larger hospital for a short period of time and do a range of births that cover off on their gap areas and maintain their accreditation. The nurse practitioner program funded 34 small rural health services last year to create new nurse practitioner roles. On top of that, we delivered 28.4 per cent pay rises for nurses and midwives, historically a female-dominated area and therefore underpaid. This is what a real commitment to rural health looks like – not one announcement but a program of reforms. It is actually change after change after change, budget after budget. I commend this bill to the house.

 David ETTERSHANK (Western Metropolitan) (15:28): I rise to make a brief contribution on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2026. Victoria was the first jurisdiction in the world to implement nurse-to-patient ratios across its public health system. They were introduced in 2000 via the Nurses and Midwives (Victorian Public Sector) (Single Interest Employers) Enterprise Agreement 2000–2004, which established minimum staffing requirements and the various hospital categorisations. These were formalised in the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015.

Nurse-to-patient ratios have been critical in improving outcomes for patients and improving workloads for nurses and midwives across the public health system. While the ratios have been amended and expanded over the years, the hospital categorisations first established back in 2000 have remained ostensibly the same. The current bill responds to the classification review into hospital levels in medical and surgical wards and emergency departments to determine appropriate staffing and midwifery workloads and staffing requirements. These reforms update the list of hospitals in schedule 1 and schedule 3 of the act and will result in 26 hospitals being recategorised to a higher level, with consequential increased staffing ratios. Seventy per cent of these will be in regional Victoria. It is very pleasing to see that the people of regional Victoria will benefit from these amended categorisations.

The Australian Nursing and Midwifery Federation have been advocating for a review of hospital classifications for a long time and have welcomed the reforms in this bill. As the title suggests, it will lead to safer patient care. It will save lives. It will support the health and wellbeing of our incredible nurses and midwives. We are blessed in Victoria to have a world-class hospital system, which is largely attributable to our extraordinary health workforce. Anyone who has spent time in hospital – and I have had three rounds of inpatient care in the term of this Parliament, so I do consider myself somewhat of an expert consumer of health products – will attest to the professionalism, the dedication and the compassion of Victoria’s nurses and midwives. It is incumbent upon us to ensure that they are appropriately remunerated and supported to develop their careers to their full potential. Likewise, it is incumbent on us to ensure that patients can expect a clinically appropriate staff-to-patient ratio. In short, this bill is in the interests of everyone. I congratulate the government for their actions in this space, and I commend the bill to the chamber.

 Melina BATH (Eastern Victoria) (15:31): I am rising to make just a few brief comments on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2026, and in doing so follow Ms Crozier our Shadow Minister for Health’s lead in not opposing the bill. I just want to make some brief comments around the bill and then particularly nurses in my Eastern Victoria Region and also the environment, the hospitals, in which they perform their amazing tasks in the service of the health and wellbeing of our good people. This bill reclassifies 26 hospitals, and those include 17 in regional and rural Victoria, some of them in my electorate. The government has allocated over $1 million to do this and promises over 250 additional full-time equivalent positions.

We support certainly the objective of this bill of improving patient safety and care and also supporting the hardworking nurses and midwives within our workforce. Indeed I really want to pay homage to and thank the nurses right across Victoria and also the learning institutions that have produced nurses. My own son is a nurse and went through Federation University in the Latrobe Valley, in Churchill, with some excellent nurse teachers in that space. He has, sadly for us, moved on to New South Wales – a New South Wales gain – and works in Westmead hospital now as a nurse unit manager. So it goes to show the level. I know he really enjoyed his time. He went through Melbourne hospitals and also the Latrobe Regional Hospital, having that breadth of experience in a different range, whether it was acute, emergency – I know he particularly liked the emergency department – or the aged.

I just want to reiterate the experiences of others, indeed Ms Crozier, who was at the very forefront on the hospital ward as a nurse, knows the important role that they play. Having experienced, in some form, being in hospital over many years, you really are at a very vulnerable stage of your life when you are in there, for whatever reason. It is those nurses who not only provide that human care, that physical care, but who bring skills in technology, understand the physical body and how that operates, coordinate with other services and the doctors and also give social and emotional support. People are vulnerable when they come into hospital, and they so magnificently start to heal the mind sometimes as well as the body, and that reassurance is all part of the healing process. We know that a ratio written into the legislation does not care for the patient; it is qualified, supported and properly rested nurses that do that. Some of the information that I have heard and learned from speaking to nurses in recent times is that our hospitals are significantly under pressure; there is no doubt about that. Indeed over the weekend I spoke to someone who was not a nurse but had worked in a hospital and had gone onto part-time and then casual. She said there was work piling up in the administrative section of the hospital, and it was really that they were short staffed, but she was not called in because there were just literally no funds. People were working extra-long hours and trying to remove that backlog within the administrative section.

We know our nurses do that shift work. If you are a night shift nurse, you are a particularly valuable type of person because that is certainly a significant impost on lifestyle. Missed breaks and overtime and occupational violence – we have seen that. I am sure that there have been many studies done on that and the importance of preventing occupational violence.

Georgie Crozier: That is why we are doing PSOs.

Melina BATH: I am very pleased that Ms Crozier was only a week ago, I think, announcing PSOs in policing – we need that. Just because someone is sick or a family is stressed, there is no excuse for creating a violent situation for our valued staff across the board. Indeed the Victorian Auditor-General’s Office (VAGO) a few years ago put out a report – it was over the whole of public health respondents in Victoria. It said that up to 40 per cent of people were experiencing burnout. In 2024 the People Matter survey said that burnout was a real issue in our hospital system. The West Gippsland Healthcare Group staff highlighted that in that survey: 40 per cent responded with burnout. That is an alarming state – 40 per cent. Thirty-four per cent responded as such in Latrobe Regional Hospital. These figures do cover all staff, so it is not just our nursing staff. The National Nursing Workforce Strategy warns that without reform the nation could face a shortfall of almost 80,000 nurses by 2035. That is significant. We all stand up here and thank our nurses and appreciate them, but on the ground things need to happen to support nurses to stay and remain in that workforce. I know Ms Crozier just read into Hansard a short moment ago the testimony of a nurse that was just so frustrated and felt that her values and health were so compromised that she could not be in that system any further.

Georgie Crozier interjected.

Melina BATH: That is a real shock, it is a real shame. She is not the only one, you are right, Ms Crozier.

I want to also point to a couple of the hospitals that are being changed under this legislation. The West Gippsland Hospital was opened in 1939, standing on that magnificent hill. But if you talk about nurses’ stress and when you look at some of the stress that they have to cope with, the corridors are narrow, the lifts are inadequate, there are leaking roofs, there is water damage, there is makeshift storage and services are dispersed across several buildings. That leads to, in itself, fatigue and an endurance level needed to have to cope with an antiquated and not fit-for-purpose hospital setting. Then look at patient beds and equipment and the like. My mum was recently in that hospital and had fantastic service. She is a mature lady, and she was treated for carpal tunnel syndrome, but I think she was actually treated in the paediatric ward because they could not find a bed for her because there was no space. Again, the nurses go to the nth degree for care and kindness, but you have to ask: when is enough enough? The government came around and promised in 2022 that it would produce a new hospital in West Gippsland, and yet we are still waiting. There is not a shovel in the ground on a donated piece of land, and I know the successive members for Narracan, both Mr Blackwood and Mr Farnham, have been huge advocates and strong citizens in advocating for this. I also know that we are going to build it if elected at the end of this year. $850 million: that is a commitment that we are not breaking like the government is.

Indeed you can expand it a bit further. We know there is an area that has a growing population, a population in need, and it has a hospital that I also know quite well, the Wonthaggi Hospital. We have committed $350 million for stage 2 and stage 3. Again, when I had a rare moment in there overnight a little while ago, the nurses were coming up to me when they found out that I was a member of Parliament – I was not dying; I had a condition, but I was not dying – and they wanted to tell me what needs to happen in our health system. They were very professional. I kept on asking them, ‘Well, what’s going on here and there?’ and they had plenty of wisdom to share with me. Latrobe Regional Hospital, under this legislation, will be upgraded from level 2 to level 3. We know that there has been burnout and concern, and we do know that there is ramping. We know that that is a hospital doing amazing work, but it is under pressure and it is under stress.

I will move to a couple of other parts in my electorate. East Gippsland’s hospital, the Bairnsdale Regional Health Service, under this legislation will become a level 2 hospital. It is the catch-all for people far, far away, from Mallacoota to Orbost and all the north and south of Bairnsdale. And I know my colleague Mr Tim Bull and indeed our candidate Gemma Rendell have got a petition out. Why is that important? Because they know that they need a stage 1, they need an upgrade, they need a new emergency department, and they need to stop that ramping. When I spoke with ambulance officers some time ago during the EBA negotiations, when they came out and spoke to us, they too were very worried about that ramping there. We need to be able to have a hospital fit for purpose now and into the future – planning into the future. The other day I was at the Heyfield Hospital, again with Gemma Rendell, and we had a good look around there. This is a beautiful hospital. People are so passionate about this hospital in the Heyfield area because it is a real blended hospital. It has got an aged care facility there and it is right beside the medical clinic. It has opportunity to grow, and it is just a really wonderful model. I know the CEO, Michele Gardner, is very passionate. She is going to squeeze every cent that she can get out of the government, but she also wants to know that it can grow and be serving that community.

In terms of bush nurses in our region, I have mentioned this many, many times, but when you go into the remote and rural regions in all of Victoria, but particularly in East Gippsland, these people are absolutely gold. They are trusted people in our communities. Talk about extending – they work beyond their hours, I am sure beyond any EBA, if they are on one. They respond in times of crisis. They are getting squeezed and squeezed and squeezed by a government that is not live to the process. There is cost impost on administration. There is cost impost on all of the services – that is, electricity and the works. There is more pressure on their budgets, and they are having to cut – which actually really, really affects them deeply, because they are part of their community – and reduce those services because they are literally not getting any extra funding. Talk about burnout – they hold the fort 24/7, and we are very, very respectful of and highly grateful for their services.

Finally, in relation to this bill, as we have seen with previous amendments in 2025, concerns remain about adequate funding, as I have just outlined, and the health services’ ability to comply with these new requirements given the current workforce shortages and overstretched hospital budgets that I have just been speaking to. I will leave my contributions there. I thank Ms Crozier for all the work that she has done over all my time here, which is 11 years – a dedicated, passionate, considered and on-the-ground shadow minister. I really hope that she can take this forward and become the minister very soon.

 Sarah MANSFIELD (Western Victoria) (15:44): I welcome the opportunity to speak to the legislation before us today and confirm that the Greens will support this bill in the name of Victoria’s hardworking nurses and midwives. In reclassifying 26 Victorian hospitals, this bill acknowledges that our health system is no longer sustainable. As the population has changed, pressure on the workforce has grown, often without the proper pay or support for staff to reflect these challenges. This has led to an overburdened health system that, despite being fuelled by the hard work of many individuals, is in a state of overwhelm. The very fact that hospital categorisations have largely remained unchanged in 25 years despite dynamic population growth across the state speaks loudly to the strain that the system has been under. So I welcome the improvements being made to patient ratios through this bill. Put simply, better working conditions for nurses and midwives at the backbone of our health system only improve patient care, health outcomes and population wellbeing as a whole.

The Australian Nursing and Midwifery Federation have played a key role in these changes, so they should be congratulated for their hard work and advocacy. When we speak to an overburdened health system, we know that it is not only nurses and midwives who are struggling. Currently we have doctors, radiographers, social workers, speech pathologists and many more allied health professionals across the state taking action because this Labor government refuses to substantially improve their pay and working conditions. Just last week Victoria’s public hospital doctors stopped work, showing this government they are sick and tired of lagging wages and unsafe conditions in hospitals across the state, and last month allied health staff made it clear that they were fed up with declining wages and a government that does not take their contribution to the health system seriously. If this government can recognise that improved pay ratios for nurses and midwives in our hospitals mean safer patient care, then why can’t it take action for the rest of the health workforce? These strikes represent much more than just the whimsical grievances of a number of health workers; they have involved a significant number of public health professionals who know that without change our health system will collapse. When the government stops putting investment in public health above all else, we know that it has been prioritising the interests of big corporations for too long.

I also want to take an opportunity to speak to the challenges being faced by regional hospitals across Victoria and particularly in my electorate. The vast majority of hospitals being reclassified by this bill are regional. While regional hospitals will welcome the opportunity for improved patient care and workforce conditions, the reality is they will struggle to fill these positions without significant support. When I speak to people living in regional Victoria, time and time again I hear about two common challenges: housing and child care. The whole spectrum of regional services struggle with recruiting and retaining experienced staff because the foundations of a sustainable workforce are not being invested in. Regional hospitals are no different. Without support, it is clear that hospitals will struggle to fill the positions created by these ratio changes. A health workforce is only as strong as the fundamental services that enable it. If key worker housing is not made available and childcare options are left dwindling, regional hospitals will only end up filling gaps with agency staff, and we know that is not a sustainable solution. So while the government might herald this bill as a win for our public health system, I want to be clear: there are significant parts of the system that are under strain, and many are looking towards the government to step up. If we can make important changes like those we see in this bill today, surely it is time to fix the rest too.

 Moira DEEMING (Western Metropolitan) (15:48): I rise also today to speak in support of this bill, because it is true that one nurse caring for four patients is better than one nurse caring for five. But that is a pretty small improvement to actually have to pass something through Parliament to get, and I think that that exposes something very, very wrong about the way that this Labor government deals with patient safety ratios and workers rights in general. These ratios should be based on objective data if they are truly for patient safety, and they should have allocated funding to support them, giving flexibility to the hospitals to respond to whatever crisis they are facing, whatever numbers they are facing, whatever complexity of case loads they are facing. Instead here we are again with an election around the corner and something that is going to look very good on a flyer.

I also find it very upsetting that the way that it is dealt with at the moment is that a hospital does not automatically get the funding for this. They get classified into a different ratio class, but then there is no guaranteed nurse workforce and there is no guaranteed funding. Instead hospitals have to collect the data, and then the government decides whether to act at all and when. So everybody has been left waiting. In the west in particular the nurses have been waiting, the patients have been waiting and the hospitals have been waiting, especially Werribee Mercy. In 2010–11, 217 patients spent more than 24 hours in its emergency department. In 2012–13 it was 264. In 2015–16 only 57 per cent of emergency patients were treated within the clinically recommended time. It has been a shemozzle for years and years and years. I had one of my babies there, and they were absolutely fantastic. I did not actually see the problems. But when I had a miscarriage and I had to go in through the emergency department and they left me waiting there 16 hours until I fainted, and seeing all the people around me, all of that was pretty devastating. We have heard terrible, terrible stories, anecdotally, from those living out in the west, about Werribee Mercy Hospital – not the dedication of the staff, not the qualifications of the staff but the absolutely unbelievable pressure that that hospital is under. The consequences of that are just harrowing for people. A few paramedics that I know say on the lowdown, ‘If you ever have to call an ambulance, don’t let them take you to Werribee Mercy.’ That is how terrifying it is. The people out in the west know that is true. They have also been waiting, obviously – waiting, waiting, waiting – for the Melton hospital.

There was a Footscray Hospital upgrade, which was of course reduced in scope before it had even started to be built. For the Melton hospital, the scope of that project has already been reduced. Again, Labor suffered a swing of 16.6 per cent against it and almost lost the seat of Werribee, and now, when it is about to lose seats regionally and in Werribee those are the places and those are the hospitals that get recategorised. I just think it is actually cruel, especially for a party that calls itself the party of workers, to make everybody dependent on the pork-barrelling done in this place, instead of establishing ratios and patient safety based on objective data tied to funding so that they can just deliver the health care that is needed, regardless of the political fortunes of the people in here.

I was also very interested to hear everybody rave about the Australian Nursing Federation, now the Australian Nursing and Midwifery Federation, which is of course the union that I grew up most closely associated with, waiting in the halls every day after school because my mother worked there. She was one of the people who worked there that did really care about nurses. In fact she cared about nurses so much that she refused to participate in the corruption that she saw going on, and they black-banned her from working in Victoria for life. That is not working for the nurses; that is not what I consider a legitimate union activity – but that is a story for another day.

The last piece of the puzzle is obviously the shortage of nurses. My eldest daughter applied for and got a grant to start a nursing degree from this government, and then they pulled the funding and she could not continue. What a waste of money from this government and what a waste of time for my daughter, and who knows how many other people that happened to. We are looking at a shortfall of 80,000 nurses. It is one thing to adjust a ratio, to make an announcement. If there are not any nurses, if there is not any money and if there is an election around the corner, I really hope that people have run out of the ability to keep hope in this government, because I just do not see how they are going to be able to deliver it, even though it is only one extra nurse on one afternoon shift for one less patient. Yes, I am going to support it, but I am not actually going to be praising you much about it.

 Sheena WATT (Northern Metropolitan) (15:54): Thank you very much for the opportunity to rise and make a contribution on the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2026. Our Labor government knows that our nurses and midwives are the lifeblood of our healthcare system. Every single day, on every single shift, they are the ones providing safe, high-quality and deeply compassionate care to Victorians at all stages of life. They are the ones that are by our side. They administer critical care, and they support our families through some of the most difficult moments of our lives. We know their jobs are incredibly demanding and the emotional, physical and psychological toll of their daily work is immense, and their roles can never be taken for granted. They give so much of themselves to keep us safe, and it is our responsibility to make sure we are keeping them safe in return. That means delivering the safe workloads, the decent conditions and the needed protections they deserve.

Since our government first introduced the original Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 we have set out minimum staffing rules, which quickly became a bit of a foundation for patient safety in this state. Those rules ensure that nurses are not stretched beyond their limits and that patients receive the focused attention they desperately need. But we also know that health care does not stand still. Our communities are growing rapidly, medical care is becoming much more advanced and the kinds of treatments people require in our public hospitals are getting more complex. The reality we face is that the hospital tiers and categories we currently use to decide staffing levels were actually drawn up more than 25 years ago, and they have barely changed since. It is simply not sustainable to manage a modern health system using categories from over two decades ago. That is exactly why we made an absolutely clear promise that we would undertake a comprehensive review of these rules to bring them into the modern era.

The Department of Health has now completed this vital work through the hospital classification review, looking closely at how busy our hospitals actually are and figuring out exactly what staffing levels they truly need based on real-world data. This bill is a direct, tangible result of this review, delivering on our promise to update the laws so that our nursing ratios finally match the pressure our hospitals are facing right now. We are making sure the law reflects the reality on the wards. Importantly, we have committed to checking those hospital workloads on a regular, biennial basis going forward. By committing to these reviews every two years we are guaranteeing that our frontline workers will never fall behind again and that our staffing levels will always keep pace with the exact needs of our community.

A massive and completely necessary upgrade to our hospital staffing laws does not just happen by accident, and it certainly does not happen without the proper resources to back it up. We are proudly backing these critical changes with a massive $109.7 million investment. This significant funding is entirely dedicated to paying an extra 253 full-time equivalent nursing positions right across our public health system. We are making sure that when we ask our hospitals to put nurses on the floor, we are giving them the funding they need to make it happen without compromising on vital services.

I want to speak about where this funding is going, because this legislation is a massive win for healthcare workers across the entire state, including in the Northern Metro Region with the incredible Royal Women’s Hospital. Given the sheer volume of complex maternity, neonatal and specialist care delivered there every single day to women and families across our community, these new ratios mean better, safer care for women when and where they need it most. This reclassification means reducing workload pressures, preventing burnout and supporting staff retention right in our backyard. As I said, this is a winner for the whole state as we upgrade the legal staffing requirements of 26 different hospitals in total. Seventeen of those are in regional and rural Victoria, proving once again that no matter where you live in this state, you deserve to be safely staffed with a high-quality public sector workforce. We are seeing major regional hubs like the Ballarat Base Hospital, Bendigo hospital, Latrobe regional and Goulburn Valley Health in Shepparton being elevated along with a huge number of other second-tier hospitals. Can I just give a particular shout-out to Echuca hospital. I know some of the team there, and they are a phenomenal outfit.

This legislation does not exist in a vacuum. It is part of the progress this government has made to build, support and completely respect our healthcare workforce. I have immense pride, actually, in saying that our Labor government will stand with our nurses and midwives every single day. We will fund them, we will support them and we will protect the laws that keep them and their patients safe. We will listen to the experts, we will back our workforce and we will back our hospitals to make people’s lives better. I am proud of the work that has gone into this legislation and enormously, enormously grateful to the nurses and midwives who look after us all. I commend this bill to the house.

 Georgie PURCELL (Northern Victoria) (15:59): I rise to speak in support of this bill, which makes some really important progress. I want to acknowledge the nurses and midwives whose advocacy has helped get us here, as well as the ongoing advocacy of the Australian Nursing and Midwifery Federation. The basic principle behind this legislation is a simple one: if we want safe health care, we need enough nurses and midwives to provide it. This bill continues a reform that began in 2015, when Victoria became the first state in Australia to legislate minimum nurse- and midwife-to-patient ratios. Since then there have been successive rounds of improvements, and this bill is a next step, reclassifying 26 hospitals, 17 of them in rural and regional Victoria, to a higher staffing level and lifting ratios in general, medical and surgical wards, emergency departments and ICUs. It is expected to add around 253 full-time equivalent nursing positions to the system, which is a really great thing.

Anyone who has been through the hospital system in a moment of vulnerability knows the importance of ratios. They save lives in many circumstances and provide emotional support at a time when many need it most. I have had many stints in hospital, particularly when I was unwell but undiagnosed with an autoimmune disease. I have always appreciated the ongoing support and care of our nurses in public hospital systems, as I said, when people are often feeling very, very vulnerable. But when a nurse is stretched across too many patients, care can be missed. As someone who, again, has recently travelled through the maternal healthcare system, I know that ratios are not just numbers on a piece of legislation; they are about whether a nurse has time to properly assess a patient or whether a midwife has time to listen to a pregnant woman who says something just does not feel quite right. These changes are important not just for the highest level of patient care but to ensure that patients feel dignity.

I want to speak a little bit about why that matters so much in maternity care, because through recently having a baby myself I have just discovered even more about the critical importance of this work. Pregnancy and birth are some of the most significant experiences in a person’s lifetime. I am sure many in this chamber would know that themselves. It is also a time when you can feel at your most vulnerable, most scared and most anxious. While this bill is a fantastic thing, I am hopeful that a lot more work can be done to build a maternity system that understands that safety is not just about clinical intervention or whether tasks and technical care are performed correctly but also about whether women are listened to. That may be whether they understand what is happening to their bodies in a healthcare setting, whether they can give informed consent to that care or whether they can have continuity of care, which I was just so lucky to have. It is a rare experience, going through the Royal Women’s and the maternal fetal medicine clinic, because I was deemed high risk with my autoimmune disease. It is hard to describe how meaningful that continuity of care is, and it is something that I know to so many women across the state, no matter how their pregnancy is categorised, would mean so much. It is about whether women feel respected and whether they can access the care that they need when they need it regardless of where they live.

Improving ratios is an important step in this, but it cannot be the end of maternity reform. Last year the VictorianMaternity Taskforce Report was handed down, which many in the chamber would be familiar with. That taskforce identified workforce recruitment and retention, limited access to models of care that support choice, gaps in strategic leadership and service planning. There was also commentary on access to culturally safe and specialist services close to home as significant challenges within our maternity system. Its recommendations are organised around four pillars: consumer experience, access to models of care, quality and safety and maternity workforce. The taskforce recommended that women should have greater choice in and control over their pregnancy and birth experience, including access to personalised models of care and continuity. I cannot speak to just how much I agree with that. I had a recommended C-section. Many of my friends had elective C-sections, and making that choice, having that decision-making power, feeling in control and feeling safe left me with a really positive experience of the birthing system. But I know for so many women that is not the case, whether that be because their birth plan is not followed or whether they experience birth trauma or obstetric violence or have an experience within the system that makes them feel as if their autonomy and consent are not respected. That can happen unknowingly, and not intentionally, through working in a strained and busy public health service, but it is really important that we build on the work to ensure that women are listened to and acknowledged in our healthcare system.

Last year, when I was pregnant myself, I met with Jess Larkin and Rowie Cooke, who are two passionate advocates for maternity care reforms with experience working in a range of different ways in the birthing space. They provided me with a document that shows that more than half of Victorian women currently receive no continuity of care across the perinatal period and that in 2023 only 5 per cent of Victorian women had access to midwifery continuity of care. As I stated, unlike most, I was very lucky to receive continuity through my pregnancy and birthing experience, and I know that that care is so important to establish that relationship and to build trust and feel safe in what is ultimately a huge life-changing decision that can leave many people feeling nervous and exposed within the healthcare system. It is the best model of care, and continuity matters because pregnancy should not be a series of disconnected appointments. Of course all of our midwives are amazing, but certainly those disconnected appointments can result in differing opinions and differing advice and women constantly repeating their history, their fears, their experiences and their circumstances to a succession of strangers. Building that relationship with the person caring for you when you are pregnant is so incredibly important from start to finish. The taskforce similarly recommended expanding similar evidence-based models of care that support women’s choice, particularly for women who face additional barriers to accessing care, and it found that continuity models can improve outcomes, improve women’s experiences and reduce burnout among midwives as well.

We also cannot talk about maternity care without talking about the experiences of women who leave the system traumatised by what happens to them. My colleague Emma Hurst in New South Wales led a parliamentary inquiry into birth trauma in the state, and it revealed harrowing stories of women within birthing systems and their experiences while bringing their babies into the world. Those experiences are not unique. In fact one in three women report experiencing birth trauma, and around one in 10 report experiencing some degree of obstetric violence. One of the reasons highlighted for this happening is in fact a lack of continuity of care, and it is considered a major factor in contributing to avoidable birth trauma. The taskforce recommended resources and workforce training to prevent birth trauma, as well as better mechanisms for women and families to provide feedback about their experiences of care and to be able to debrief on that. So often when women have babies we focus on the fact that the baby is born and the baby is healthy, which results in a minimisation of autonomy and experience, and things that are as small as changes in language in birthing settings can go a really long way to reducing birth trauma in our hospital systems. Women should not have to wait until something goes catastrophically wrong before their experience is taken seriously, and any experience that leaves a woman feeling vulnerable or that their autonomy and consent were not considered should be taken with seriousness at any level. The taskforce found that Victoria lacks maternity-specific workforce planning and identified the need for better strategies to address workforce shortages, burnout, retention, career pathways and distribution of skilled staff across the state, which again has been acknowledged as one of many wonderful things that would help reduce birth trauma as well.

Lastly, I just want to touch on regional access. As noted, this bill makes some great changes when it comes to regional and rural hospitals, and I am pleased that the bill specifically addresses those challenges and improves the level of care in regional areas. I have heard the contributions from a range of regional MPs like me, and often we hear in our communities the very real issues in receiving care, whether that be as a hospital patient or as a pregnant woman on her birthing journey. Certainly even just where I live we have lost a range of birthing facilities, which significantly impacted women in the Macedon Ranges until Castlemaine was re-established and certainly left women with an option either way, which can be a lot of time when in labour or ready to have a baby. There is more work to do to expand regional care and to ensure that your postcode does not determine your experiences in the hospital system, particularly when it comes to maternity care and providing those services to women who might be high risk or require a different level of care than another patient.

In closing, this bill is welcome, and stronger ratios are an absolutely incredible thing for our nurses, midwives and of course patients in Victoria’s public hospitals, but I am just really hopeful that the government and any future government will acknowledge the need for continued work to improve maternity care and support for parents in our state. While a number of recommendations from the Victorian Maternity Taskforce Report were immediately accepted, there are more to be built upon and other ones to be accepted, whether that be expanding regional services, stronger midwifery leadership, ensuring women have genuine choice and control or of course acknowledging the very real impacts of birth trauma, which are currently often left out of the conversation or not considered when we speak about this type of work. I am hopeful that it does not stop here and that this government or any future government will be committed to improving the experiences of women in birthing systems in our state. It should not just be about getting women and babies safely through the hospital door. It must be also about ensuring safety and respect and ensuring that women feel heard and empowered throughout their entire journey, because we know that when that happens the experience of motherhood and the experience of the child benefit as well.

I am grateful for this piece of legislation, and I am hopeful that some of the work in the taskforce that has not been acted on will be, because it was a great piece of work by the government. But that work now needs to be built on and acted upon, and I am really hopeful of seeing that happen. I commend the bill to the house.

John BERGER (Southern Metropolitan) incorporated the following:

President, I rise to make a contribution on Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Amendment Bill 2026.

I would like to thank the Minister for Health for her ongoing work on this issue, and for her support of nurses and midwives, who are a critical part of our healthcare system.

The amendments contained within this bill aim to achieve one thing, ensuring that Victorians can access safe and high-quality healthcare in our hospitals, all the time.

It was the Andrews’ Labor Government initiative and care for both health workers and patients that started the Safe Patient Care Act.

It was under a Labor Government in which healthcare workers were protected from ridiculous demands and overworking, due to short staffing or patient demand.

And it was under a Labor Government in which all of this was enshrined into law.

It was under a Labor Government in which patients were guaranteed a high standard of care, due to the fair work conditions of nurses and midwives.

Labor is committed to making sure that Victorians have the very best healthcare, with stronger and safer nurse-and midwife to patient ratios.

Since the Safe Patient Care Act was introduced in 2015, the demand on Victorian public hospitals has increased.

Both patients and workers should feel supported in our healthcare system and not stressed or let down.

The Safe Patient Care Act established minimum nursing and midwifery staffing requirements for publicly funded health services.

The workloads on midwives and nurses impact the quality of patient care, and that shouldn’t be compromised due to increased demand.

Since then, the Labor Government has delivered many ratio improvements, further assisting healthcare workers.

These changes followed our commitment to protecting the rights of midwives and nurses, enshrining these protections into law.

20 years ago, public hospitals were first classified into tiers, based on patient and care complexity.

Tiers were then used to determine the minimum number of staff required per patient, ward, or bed.

This merely acted as a minimum and does not prevent the operator of a hospital from staffing a ward with additional nurses or midwives.

These classifications were enshrined into legislation with the Safe Patient Care Act, in 2015.

This was done to ensure adequate staffing levels for nurses and midwives, and to protect both their working conditions, and the quality of treatment provided to patients.

President, in December of 2025, we began our review into the classification of Victorian public hospitals, upholding our promise to nurses and midwives across the state.

The amendments to this bill follow our review in the classification of Victorian public hospitals.

This review used data-driven algorithms, through the use of publicly available datasets across the Victorian healthcare system.

It aims to more effectively classify hospitals and protect the high standard of the Victorian public health system, which Victorians are accustomed to.

Public hospitals across Victoria are classified as into “schedules”, with each schedule having a unique set of classifications.

Schedule 1 hospitals contain general medical and surgical wards, that are specialty or non-specialty.

Schedule 3 hospitals are those that possess an emergency department.

Furthermore, within each schedule, every hospital is given a weighting of between 1.0 and 1.6, given by the Modified Monash Model.

The Modified Monash Model takes into account the number of hospital bed days, emergency department presentations, the average number of hours of ICU care, and the number of Neonatal Intensive Care Unit and Special Care Nursery babies that are admitted.

The bill updates the categorisation of hospitals within a schedule, in accordance with the findings of this review.

This update means hospitals must roster more nurses for the same number of patients, with higher ratios of registered nurses to patients improving patient outcomes through reduced length of stay and fewer adverse events.

Correctly aligning staffing levels with the capacity or complexity of a hospital, the patient experience is improved.

And importantly, this supports the rights of nurses and midwifes.

From my time as both State Secretary and National President in the mighty Transport Workers Union, I understand the impact and importance of securing fair working conditions for people, and why they are so important.

This amendment sees the workload of nurses and midwifes be set at reasonable levels, as these people who perform such critical roles cannot be subject to being overworked, when trying to care for others.

The public health system should not be a place where it’s workers are exploited in service of simply being able to care for more patients.

Australia has always been at the forefront of the union movement, with Australians advocating and fighting for better conditions for over a century.

I’m proud to support a bill that keeps the interests of workers at hearts, while also improving the care experience for patients alike.

This means less pressure on our hardworking nurses, preventing burnout and retaining the workforce.

As a result of this amendment, 26 hospitals will be recategorized into a higher level, with 17 in regional and rural Victoria being reclassified to a higher level.

That means 26 more hospitals with increased nurse to patient and midwife to patient ratios; 26 more hospitals that can effectively care for more patients, and 26 hospitals where nurses and midwives have better working conditions.

The amendments in the Safe Patient Care Act are backed by a $109.7 million investment.

The implementation of these changes will occur in phases, to support a smooth transition for all facilities and hospitals.

This will allow health services to incrementally adjust to the increase in staffing requirements and not be overwhelmed by the changes.

Additionally, this enables proper training for graduate nurses, to uphold the superb standard of care that Victorians are accustomed to and deserve.

These nurses can then join the workforce in time with the phased rollout, guaranteeing a smooth transition.

The uplift in nurses and midwives will begin in the 2027/28 financial year, starting with general medical and surgical wards.

Emergency departments will follow the transition in the 2028/29 financial year, with intensive care units starting the uplift in nurses and midwives in the 2029/30 financial year.

The changes from the review will provide a massive boost to staffing in hospitals right across Victoria, making sure our great state can keep up with the demands of its citizens.

This bill will mandate 253 additional full-time equivalent nurses in the public health system, a necessary and beneficial improvement.

Supporting our hardworking nurses and midwives should be a priority, and the Carroll Labor Government wholeheartedly agrees.

Giving nurses and midwives more support on the ground with better conditions will prove beneficial to all parties concerned.

Health workers are better protected from overworking, and the quality of patient’s care is not compromised by the workload of nurses and midwives.

We’ve also committed to strengthen the Graduate Nurse and Midwifery program, with an investment of $26.078 million, to deliver an additional 250 graduate nursing and midwifery positions in the health system.

This Government has a strong and consistent track record of supporting our health workforce, through better conditions and increases in pay.

Nurses and midwives are the backbone of the Victorian public health system and should having working conditions and pay that match.

This is not the only way that we’re focusing on healthcare, as the Carroll Labour Government is committed to bolstering healthcare across Victoria.

We’re backing our health professionals, guaranteeing that Victorian health workers are getting a fair go, in return for the vital work they do.

Their skills and expertise have been recognised, with their new agreement reflecting our dedication for maintaining a quality system for patients and workers alike.

Healthcare workers have received a 28 percent pay increase over the next 3 and a half years.

They will also receive a one-off payment of $1500, as well $3500 a year for professional development, five days of paid reproductive leave, better classification structures, and clearer career progression.

Additionally, we delivered a 28.4 percent pay rise for nurses and have consistently strengthened nursing to patient ratios.

Our workforce deserves better pay and improved conditions, and the Carroll Labor Government is proud to have delivered this.

President, while hospitals are critical part of the healthcare system, the frontline of health in Victoria are paramedics, and we’ve also delivered improvements in this area.

Recently, we welcomed more graduate paramedics to our ranks, reinforcing our already world-class force, and supporting them even more.

In the last year, we have recruited 294 graduate paramedics, and since July more than 80 graduate and qualified paramedics have joined the service.

Additionally, we have also welcomed 4 new Mobile Intensive Care Ambulance (MICA) paramedics into Ambulance Victoria.

The MICA paramedics are specialists who are trained in advanced intensive care, and who can help those who are the most ill or injured.

This Labor Government is backing in our paramedics, to make sure our workforce meets the demands of Victorians, securing better conditions for those who do such important work.

This new cohort of paramedics will hit Victorian roads on Monday the 14th of September; a huge win for all Victorians.

Amongst all of this, regional Victorians and their needs cannot be overlooked.

People from regional centres in Victoria can face challenges accessing healthcare and support, so we’re continuing our investment into these communities.

The Carroll Labor Government understands this, and we’ve invested in a $655 million redevelopment of the Ballarat Hospital.

The redevelopment includes an array of improvements, including a new emergency department, 100 more short stay beds, a new theatre suite, a new helipad, and new and expanded perinatal and critical care hubs.

This amounts to an extra 14,500 inpatients being treated each year, as well as 18,000 more emergency.

Extra capacity means expanded care for locals that’s faster and more effective.

We’re ensuring that Victoria’s world-class public health systems stay protected, and that this quality extends for decades to come.

Victorians should live their whole lives in a state where public health is a priority, and this Carroll Labor Government has committed to it.

We’re also building more accommodation for health workers in Wonthaggi, at Bayside Health’s Wonthaggi Hospital.

This new space provides 20 rooms for health workers, such as doctors, nurses, visiting specialists and allied health staff.

Attracting and retaining staff for regional hospitals is always a focus, and these works will help to achieve that.

This retention of staff will expand the care and capacity of services available at Wonthaggi Hospital, securing the best possible care for all residents and locals.

This work in Wonthaggi is on top of the similar projects that have been completed or are underway in Kerang, Kyabram, Benalla, Goulburn and many others.

This is a part of the more than $50 billion that the Carroll Labor Government has delivered for our regions.

We’re supporting our regions, giving them the tools and assistance necessary to service their local residents and population.

President, the Carroll Labor Government has also brought healthcare closer to home for many people in the West, with the opening of the bigger and better Footscray Hospital.

This new $1.5 billion facility has been providing state-of-the-art services to thousands of Victorians.

In the six months since the facility was opened, it has cared for 19,000 admitted patients, on top of supporting 23,000 presentations to the emergency department.

This relieves pressure on other hospitals and provides convenient access to care for many patients.

Having a hospital on your doorstep or within a short trip, can make all the difference in life-threatening scenarios, and we’re proud to supply this change to Victorians.

Convenience also removes a barrier to receiving treatment, encouraging people to utilise our amazing healthcare system, making sure that small problems don’t escalate.

Once Footscray hospital is fully operational, it will have more than 500 beds, an increase of 200.

This will allow the hospital to treat and additional 15,000 patients every year, expanding the service even further.

The new Emergency Department will be able to support another 20,000 patients each year, and additionally has a dedicated mental health, and alcohol and drug hub, to reduce strain and pressure on the general Emergency Department, whilst increasing safety.

Footscray Hospital also boasts an increase in resuscitation bays, fast-track bays, acute and short stay beds, on top of a high-tech satellite radiology hub.

All these changes mean that patients can see a dedicated specialist faster and easier, so they can receive the care sooner.

President, the health of young people, and particularly young women has been underrepresented, and they face barriers to receiving treatment, or severe delays in diagnosis.

Quite frankly, this is unacceptable.

All patients in Victorian hospitals deserve to be treated with an equal level of care and consideration.

That’s why we’re making it easier for those who are experiencing painful periods, pelvic pain conditions and endometriosis to receive the specialised care and support they require.

Conditions like these can lead to debilitating pain and can disrupt daily life for young people, and it should be easier to receive treatment.

We’re introducing a Victorian-first, dedicated Kids and Teens Pelvic Pain Clinic, which is available at the Royal Children’s Hospital.

Through this service, a specialist Nurse Navigator will triage patients, and connect them with the right care, that’s closer to home.

President, now young people and their families can access potentially life changing care closer to home, with less barriers and hurdles.

Distance or convenience shouldn’t stop young women from receiving care.

This is just another way that we’re continuing to deliver faster and more effective healthcare services to Victorians, and the Carroll Labor Government will continue to fight for better.

Victoria cannot continue to provide world-class public health to millions of Victorians, without proper investment and funding, as well as protecting those that provide these services.

Protecting and improving Victoria’s public health system is an ongoing effort, and this Labor Government supports all those workers who deliver it.

I commend this bill to the chamber.

Ryan BATCHELOR (Southern Metropolitan) incorporated the following:

Victoria has a world-class healthcare system, and Victorians deserve the very-best healthcare. That is why this Labor government enshrined strong nurse-to-patient ratios in law last year, and with this bill is strengthening them even further.

The Safe Patient Care Act 2015 sets out how to determine staff-to-patient ratios in particular hospitals based on its capacity and complexity to ensure patients receive the best care possible and a safe workload for staff. This is then used to categorise hospitals in the Act’s schedules to set a staff-to-patient ratio that reflects the needs of that specific hospital. In developing this system, the Government worked closely with the Australian Nursing and Midwifery Federation, health services, and the Victorian Hospitals’ Industrial Association.

The bill before us will amend those schedules to promote a further 26 hospitals into a higher category for the purposes of nurse-to-patient ratios and midwife-to-patient ratios.

These reforms will add an additional 253 full-time equivalent nursing positions to Victoria’s world-class healthcare system. More nursing staff means increased patient safety, improved patient outcomes, and reduced hospital stays.

And I’m proud to say that two of the 26 hospitals receiving higher staff-to-patient ratios will be the Sandringham Hospital and the Victorian Heart Hospital in my electorate.

The Sandringham Hospital is a crucial asset to residents in the Southern Metropolitan Region that has already benefitted from $5.62 million towards the refurbishment of the hospital’s outpatient facilities.

The Victorian Heart Hospital was delivered by this Labor Government as Australia’s first state-of-the-art, specialist cardiac hospital providing innovative, patient-centred care. The Heart Hospital was not previously categorised, so these amendments will ensure that patients can continue to receive the best care possible with enshrined staff-to-patient ratios.

Patients and staffs have benefitted from modern and upgraded consulting rooms, clinical areas and public spaces to boost healthcare outcomes, reduce patient wait times, and support the hospital’s committed workforce in increasing their capacity for specialist medical, nursing, and allied health care.

To allow health services to incrementally adjust to the increased staffing requirements, a phased approach will allow the uplift to occur gradually starting from the 2027/28 financial year.

Labor understands that our healthcare system is only as good as the thousands of workers who keep it running smoothly – which is why Victoria has a world-class health system.

Victoria’s world-class nurses and midwives devote themselves to caring for Victorians, and this Victorian Labor Government has a strong track-record of backing in our health workforce.

Our reforms to staff-to-patient ratios not only benefit patients, but they benefit workers. They deliver manageable workloads for staff, reduce the pressure on our hardworking staff, and deliver safer working conditions for nurses and midwives.

We are continuing to strengthen the pay and conditions of our health workforce including nurses and midwives who received a 28.4% pay rise, and medical professionals who recently agreed to a 28% pay rise over the next 3.5 years.

We are making it easier for students pursuing nursing or midwifery through our $270 million initiative making it free to study nursing and midwifery, as well as investing $26 million to strengthen the Graduate Nursing and Midwifery Programme through deliver of an additional 250 graduate nursing and midwifery positions in the health system.

We are backing workforce recruitment, retention, and professional development in regional and rural areas to ensure that no matter where you live in Victoria you have access to world-class healthcare. In fact, of the 26 hospitals receiving a higher staff-to-patient ratio, 17 of these are in regional areas.

Victoria has a world-class healthcare system, and Labor is making sure that Victorians continue to have access to the very best healthcare with stronger, safer nurse- and midwife-to-patient ratios.

 Ingrid STITT (Western Metropolitan – Minister for Health, Minister for Mental Health, Minister for Ambulance Services, Special Minister of State) (16:11): I thank all members for their contributions and note the broad support that has been expressed for these reforms in the chamber today. The Victorian Labor government is making sure that patients have the very best care with stronger, safer nurse- and midwife-to-patient ratios. This bill will further strengthen nurse-to-patient ratios right across the state by reclassifying 26 hospitals, including 17 in rural and regional Victoria, to a higher level. I note that a number of members have made note of the changing nature particularly of regional hospitals. This will help ensure hospital classifications in the act are contemporary and better reflect our growing, changing health system.

As we have been discussing in the second-reading debate, this bill will change how hospitals are categorised in the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015, updating the law so that certain hospitals are recategorised at a higher level for the purposes of required nurse-to-patient and midwife-to-patient ratios. This means they must roster more nurses for the same number of patients, improving staffing and patient care. This will improve mandated nurse-to-patient ratios at 26 hospitals across Victoria in general, medical or surgical wards, emergency departments and intensive care units. We know that higher ratios of registered nursing staff to patients increases patient safety and improves patient outcomes through reduced lengths of stay and fewer adverse events. It also means less pressure on our hardworking nurses, preventing burnout so that we can retain our incredible health workforce. The additional roles will also create more opportunity for graduates and early career nurses.

The hospital classifications reflected in the act were first established over 25 years ago and have remained largely unchanged since then. The hospital classification review was conducted to develop a contemporary approach to assessing a hospital’s workload and determining appropriate staffing requirements, and the assessment of classifications was determined based on this transparent and objective methodology. I certainly want to acknowledge the work of the Australian Nursing and Midwifery Federation (ANMF) and the Victorian Hospitals Industrial Association and health service leaders during the development of the review.

This bill will add over 250 full-time equivalent nursing positions to our health system, and the amendments to the safe patient care act are backed by $109.7 million of investment. I note that a couple of members questioned whether the funding would be available for these additional nursing and midwifery roles, and we have certainly backed it in with that investment. The commencement dates for the recategorisation have been staggered to support an orderly implementation of the changes. That is not dissimilar to how we have managed previous rounds of improvements to ratios. This will support staffing recruitment, including for specialised roles, as well as support operational readiness, providing affected hospitals with sufficient time to prepare for any obligations. It will also enable appropriate training for graduate nurses, who can support the uplift needed. The uplift will start with general medical or surgical wards in the 2027–28 financial year, emergency departments in the 2028–29 financial year and then intensive care units in the 2029–30 financial year.

We know that building and supporting our workforce is key to safer patient outcomes, and we are taking strong action to support recruitment and retention right across the state. Safer nurse- and midwife-to-patient ratios are part of that work, and when you have better working conditions and more support on a ward, you do reduce burnout, making Victoria one of the best places to be a nurse. We are also continuing to deliver on the $270 million Making It Free to Study Nursing and Midwifery initiative. We have also strengthened pay and conditions for a number of key sector workforces, including nurses and midwives, and we are investing $26 million in this year’s budget to strengthen our graduate nursing and midwifery program through the delivery of an additional 250 graduate nursing and midwifery positions in the health system.

We are also continuing to support workforce development in regional and rural Victoria, and a couple of my colleagues have already gone to these specific programs, such as the rural urgent care nurses capability development program, which supports registered nurses working in urgent care centres in rural and regional Victoria to provide safe high-quality care. In 2024–25 alone 349 nurses were supported through online learning modules, face-to-face workshops and clinical placements, and the Maternity Connect Program supports midwives and nurses working in rural and regional health services to maintain their skills by providing short-term clinical placements in larger regional or metropolitan maternity health services, supporting them in their professional development and skill improvement. There are a number of other targeted initiatives that I am sure we will discuss in the committee stage.

This bill, whilst quite narrow in scope, is very good for Victorian patients and good for our health workforce. I would like to thank, again, all members for their contribution. I would also like to acknowledge our nurses and midwives, who do the most incredible work and deliver world-class care to Victorians across the state every day. I also want to acknowledge the leadership of the ANMF, who are in the gallery today, and thank them for their tireless advocacy and for working with the government on these very important changes. I understand that there are some questions in committee. I commend the bill to the house.

Motion agreed to.

Read second time.

Committed.

Clause 1 (16:18)

Georgie CROZIER: Minister, I just wanted to raise a couple of points just to get some clarity, if you would not mind. Has there been any risk analysis by the department on whether the new staffing ratios will lead to budgetary restraints in other areas of hospital budgets, such as planned surgery or any other services that will be impacted, given some concerns that have been raised? Also we know that health services are under huge budgetary constraints at the moment.

Ingrid STITT: As I indicated in my summing-up, the amendments to the act are backed by $109.7 million of investment, and that is to fully fund the 253 FTEs and nursing positions across the identified health services. That of course, as we know, will recategorise 26 hospitals, 17 of those being in regional and rural Victoria, to a higher level. So the government has committed the funding that will be required to roll out these changes.

Georgie CROZIER: I think in my contribution I accidentally said that in the last legislation there was $270 million – I meant 270 FTE with $101 million. Just with that $109 million in the latest announcement to implement these 253 FTE, and the $101 million for the 270, how will you be allocating that across the 26 services that you have identified, especially in this latest tranche of legislation?

Ingrid STITT: Noting that there is a phased approach to the implementation with the general medical or surgical wards changes being implemented by 1 July next year, and then 1 July 2028 for emergency departments and 1 July 2029 for intensive care units, the FTE and the funding have been developed taking into account the changed needs of those hospitals and the review that went into looking at what the workloads were and what the appropriate categorisations ought to be. The funding that has been arrived at has certainly been driven by a number of factors taken account of, including, obviously, the wage rates, the EBA, shift allowances, overtime et cetera, in a similar methodology to the way in which the wages component of the previous tranche of changes to ratios were developed.

Georgie CROZIER: I will go back to the numbers, the FTE, in a minute. You just mentioned the review, and I have a question around that. I understand that the algorithms document is available on the department’s website, but not the actual review. Is that publicly available, the hospital classification review that was done by the department?

Ingrid STITT: Certainly the algorithm has been provided. The work of the review was really looking into what the workload and requirements to meet higher ratios would be. I can certainly check that with the advisers box as to whether there was actually a review report provided, but the work was done in a process that involved the Australian Nursing and Midwifery Federation (ANMF) and the Victorian Hospitals Industrial Association, and also there was consultation with a number of health services CEOs to ensure that the review was taking account all of the factors that need to be considered in changing the categories in the act.

Georgie CROZIER: Are you able to check that?

Ingrid STITT: Yes. I can check that, certainly.

Ms Crozier, the document that is provided on the department’s website is the review document, which includes the details of the algorithm.

Georgie CROZIER: Okay. I will go back and have a look at that. I just cannot recall if it had all of those stakeholders and the CEOs referenced in that. I will check that out.

We have just spoken about how in the 2025 legislation there were 270 FTE, and this year there are 253. In the briefing we raised issues around the implementation of that amendment from last year. From memory in the committee stage at the time, I think it was you, acting on behalf of the minister in the other place, who said the additional 270 FTE nurses were required for full implementation of those changes, which is the same as what is proposed with this. When I asked in the briefing whether all of these positions had been filled by the date, with full implementation, of 1 July this year, it was unknown in the briefing, so nobody could tell me if that had actually occurred. So it was taken on notice, and the response I received was:

100 per cent implementation of the April 2025 legislative amendments came into effect on 1 July 2026.

Data post 1 July 2026 is not yet available.

It is completely not answering the question I asked. I was asking about the 270 FTE. Can you confirm that the 270 FTE positions have all been put in place as of 1 July 2026?

Ingrid STITT: Ms Crozier, just going back to the issues that you raised in the briefing and the explanation that you were given, 100 per cent implementation of the April 2025 legislation amendments came into effect on 1 July this year. Health services are required to adhere to those requirements in the act. I think that the answer that was provided to you was in relation to implementation of these mandated ratios and what information we are able to source from health services, and it is not currently available in a consolidated form, so we will be gathering that data. But the data post 1 July 2026 is not yet available. Obviously, there are requirements in the act around adhering to the ratios, and there is a process available for any noncompliance.

Georgie CROZIER: Minister, you just said you are gathering that data, but how are you tracking the progress of those additional staff that are required to ensure that the implementation of the 2025 legislation is actually taking place? How is that being done?

Ingrid STITT: Health services are required to comply with the act and have the appropriate staffing arrangements in place, and they are, as you know, closely monitored by our nursing staff but also the ANMF, and there is a process in place if it is thought at any time that ratios are not being complied with.

Georgie CROZIER: But that is my point. If you are gathering data but you are saying the health services have got to put this in place and if they do not there are going to be penalties or something will happen, how do you know? When do you know, given that staffing can be very fluid in a health service? You have provided funding for 270 FTE, yet we do not know where they are or how long it is going to take to have that full complement put in place. I will just say that. How are you tracking that? How is the government, the department, tracking that with the health services that are being impacted? Are they asked every month to give a progress report on meeting the ratio requirements? How, with those 270, do we know? Because otherwise it is just a figure that you have plucked out and you cannot measure it. I am trying to understand how you are tracking it.

Ingrid STITT: The government has funded health services to deliver additional nursing and midwifery staff to comply with the requirements under the act. There are obviously regular performance meetings with each health service, in accordance with the normal process of managing both budgets and also performance of our health services, and this would be no different in that regard. We would be looking to see whether health services are implementing the changes that the law requires. I do not want to give you the impression that these changes have not been implemented, but what I am saying is that there might be some circumstances where health services may need to engage either an agency or a casual to maintain service capacity under certain circumstances – it might be sick leave or it might be a particular circumstance in a ward. But they are still required to adhere to the act, and the funding has been provided by the government in order for them to do that.

Georgie CROZIER: Given there have been several tranches prior to what we are discussing just now, how many breaches have there been with health services that have not been able to meet the ratios under the previous legislative requirements?

Ingrid STITT: Perhaps the best way to answer that is to talk about what the process is in the act if there is a suspected breach of the mandated ratios. Under section 41 of the act, a nurse, a midwife or a worker representative may notify the hospital operator of an alleged breach of a ratio or ratio variation.

Georgie CROZIER: The dispute resolution process.

Ingrid STITT: That is right, yes. The information on these arrangements is managed and held at that individual health service level. There is the ability, under section 42 of the act, for that dispute to be escalated to the Magistrates’ Court, which can impose civil penalties on the health service, but the Department of Health has no record that that has ever been triggered or occurred as a process to date.

Georgie CROZIER: That is good news. Has any health service said to the department that they are really struggling with being able to consistently meet these ratios and therefore been provided with an exemption because they are undertaking the service? As we have discussed in previous debates, when the legislation was brought in, we understand that there are exemptions in place and they can apply for them given the circumstances. But has the department identified any areas in rural and regional Victoria, which it really is affecting – not so much metropolitan Melbourne – where there are significant concerns with health services being able to meet those ratios?

Ingrid STITT: I can certainly seek some advice on that, but I think that we have got some recruitment, support and retention programs that are targeted to assist regional and rural Victorian health services, noting that they can sometimes be the areas that are harder to staff. So we have got a mix of training pipelines and we have got the financial incentives, recruitment support, professional development and the broader workforce reform to attract nurses to rural and regional areas. And there are a number of programs, including the rural graduate nursing and midwifery programs, the scholarship and education supports, the Rural Workforce Agency Victoria support and the professional development and career progression. We do not provide exemptions for ratios. The process in the act is followed if there is an exemption sought.

Georgie CROZIER: That is what I am referring to.

Ingrid STITT: Yes. So there is a process in the act, but the department itself does not provide the exemption. There is a process that is followed at the health service and local level. But I guess the point I am making is that we have got a strong program of supports in place to assist regional and rural hospitals to recruit the workforce that they need. And I think the strong growth in our nursing numbers – some 17,000 since 2015 – certainly bears out that we have seen year-on-year growth in our nursing ranks.

Georgie CROZIER: With a growing population we are going to need more nurses, so we need those. The implementation period to 1 July 2029 provides an opportunity for detailed workforce planning, as outlined by the Australian College of Critical Care Nurses. They want to know what modelling has been undertaken to determine the additional ICU nursing workforce required as a result of the proposed changes. My questions are: has modelling been undertaken to determine the additional ICU nursing workforce required because of the proposed changes? And what are the workforce needs by hospital for each of those hospitals that have now been designated in a different schedule? Has that all been determined through that consultation that you did with CEOs and ANMF and the Victorian Healthcare Association? I suppose it is around that modelling in the lead-up to 2029 with those hospitals.

Ingrid STITT: That process is the modelling, so the classification review work and the algorithm, which looked at what the workload –

Georgie CROZIER: I do not think that is publicly in the review that we were talking about.

Ingrid STITT: The work of the classification review did look at a more contemporary approach to assessing a hospital’s workload and in turn determining the appropriate staffing requirements. You would know from the previous bill and legislative changes previous to 2025 that we have taken a phased approach so that we can support the staggering of the implementation of the changes and try and ensure that hospitals have got time to do the recruitment necessary to adhere to the act.

Georgie CROZIER: So I take it that you are very confident that the pipeline of nurses coming through can meet future demand?

Ingrid STITT: Yes. This is an opportunity as well to create more positions, and I think that will be warmly received in regional Victoria.

Georgie CROZIER: They are certainly struggling. I spend a lot of time speaking to regional nurses and others in the regions around the issues arising, which are very alarming. Has modelling also been undertaken to determine demand for bedside nurses, team leaders and the liaison nurses, which is also part of the suite of what you are talking about in the various pieces of legislation that have been brought in over the last few years?

Ingrid STITT: As the bill outlines, the uplift will start with general medical or surgical wards in the 2027–28 financial year and then move on to emergency departments in 2028–29 and then intensive care units in 2029–30. There are a number of areas where that will be applied, including workforce availability. A recategorisation will trigger those higher staffing ratio obligations. Some hospitals may have a degree of operational readiness already, but we have taken the deliberate approach of giving them time to stagger the changes. Some hospitals may need to expand services or reconfigure wards before the new categorisation can take effect. So there are a number of different factors that the staggering of the changes allows hospitals to manage. There might be risk management and continuity-of-care considerations, and consistency with previous implementation approaches has shown us that the best way to do this is to stagger the reforms.

Georgie CROZIER: How many hospitals need to be reconfigured to meet the ratios?

Ingrid STITT: These are examples of what hospitals might need to consider in implementing the 253 FTE across the three tranches of implementation.

Georgie CROZIER: I am not disagreeing with you, but I am understanding that you are saying that to manage this there is going to be some reconfiguration, so that would have been in the modelling. Likewise, with agency staff over the next little while, has that modelling been done to see if there are additional agency staff required in any of these areas?

Ingrid STITT: The FTE numbers that we are funding are based on the reclassification findings and what will be needed to deliver the higher ratios.

Georgie CROZIER: Does that FTE include agency staff, then? Is it permanent FTE or is it a mix of both? And if it is a mix of both, what does that mix look like?

Ingrid STITT: It has been modelled on FTE. Certainly the industrial requirements of the EBA will be relevant as well in terms of modelling the numbers.

Georgie CROZIER: Given that there are concerns now from various stakeholders about areas where there are shortfalls, particularly areas like emergency departments and intensive care units, and when you look at some of these areas where they have got an ageing workforce, especially in regional Victoria, I think it is only fair to ask: what is the agency component that has been considered as part of those numbers of FTE? Was that work done, or are you saying, ‘No, we’re just hiring permanent staff. They’re available. We will not need any agency staff’? What I am asking is: if you need agency staff, of those 270-odd FTE or 253 FTE, what component of agency staff will that require?

Ingrid STITT: Ms Crozier, the model calculated the additional FTE required and applied the wage assumptions of FTE to the numbers that we have funded in –

Georgie CROZIER: Agency staff are different.

Ingrid STITT: I understand that, but we are not intending to uplift ratios by hiring a bunch of casuals or agency staff. We have calculated the costings based on FTE in accordance with the EBA requirements.

Georgie CROZIER: Are you saying there will be no agency staff required to meet the ratio requirements?

Ingrid STITT: I want to be careful in answering this, because of course there are circumstances across the health system where agency staff are utilised. But the FTE that has been calculated and the work that has been done in developing the reclassification and the work of the reclassification review are based on FTE.

Clause agreed to; clauses 2 to 7 agreed to.

Reported to house without amendment.

 Ingrid STITT (Western Metropolitan – Minister for Health, Minister for Mental Health, Minister for Ambulance Services, Special Minister of State) (16:44): I move:

That the report be now adopted.

Motion agreed to.

Report adopted.

 Ingrid STITT (Western Metropolitan – Minister for Health, Minister for Mental Health, Minister for Ambulance Services, Special Minister of State) (16:45): 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.