Get Involved - Parliament

Health Policy

Published on: September 2022

Record: HANSARD-1323879322-127417

Health Policy

Mr RYAN PARK (Keira) (17:00:00):

I move:

That this House:

(1)Notes that between April and June 2022:

(a)more people presented to New South Wales emergency departments with T2 level critical emergencies than ever before—over 110,000 in just one quarter;

(b)one in 10 patients spent longer than 21 hours and 16 minutes in the emergency department—the longest on record; and

(c)across New South Wales, 76,117 patients left emergency departments without completing treatment—the highest on record.

Before addressing my remarks to the motion, I acknowledge the member for Oxley, who will be missed in this place. She is a hardworking member and one I think we could all learn from. Today is an important day. This is an important motion because what we are dealing with in hospitals at the moment simply cannot continue. It would be easy to say that we can fix it quickly. We cannot. It is going to take time. Because at the moment, right across New South Wales, 76,000 patients have left an emergency department without completing their treatment—that is the highest on record. It is important to focus on our emergency departments because they are now at the front line of the crisis in our healthcare system.

When we have people waiting sometimes multiple days in an emergency department without being treated, we know something is going wrong. We know in our hearts and in our heads that there has to be a better way. The Opposition is saying to the Government that it has to listen to frontline paramedics, frontline allied healthcare workers, and frontline nurses and midwives. These are individuals who give a damn about patients. They are not in this for press releases, media stunts and TV interviews. They are in it to make sure whoever is in government starts the process of reform in terms of the way in which staffing is rolled out right across the healthcare system.

On the weekend we focused on a part of New South Wales that is very near and dear to my heart—that is rural and regional New South Wales—and the health care in those towns and villages across New South Wales. Labor fought hard to establish the rural and regional health inquiry, something the Government fought at every step. That was arguably a landmark inquiry, with over 700 submissions, multiple hearings around New South Wales, a bank of evidence from the north to the south and right across to the west that we need to do something different in our hospitals. We on this side are listening. We said we would implement the recommendations of that inquiry. On top of what the Government announced in paramedics, Labor said it would assign an additional 500 paramedics dedicated to those rural and regional communities that often feel they get left out and miss out. I have heard that from them.

Today Labor also made a commitment of 1,200 nurses and midwives recruited across the Government but, most importantly, across the next four years, if Labor is given the privilege of governing in 2023. It is a cost of $175 million and it is a down payment—the next plank in the stage of reform. No-one, me included—and I would like to say the Minister as well—should say that there is a silver bullet for this. There is not. This will be a process that is done in consultation with our healthcare workers and with NSW Health, if we are elected. But we have to change the way in which we staff our hospitals, because the current model is not working.

The Minister said today it was a Labor Government that introduced it. That is fine, I am happy to say it needs to change. I am not here defending something that in 2022 needs to improve. The Leader of the Opposition has made it clear to me and to the shadow Treasurer that we believe there has to be a different way of delivering health care. That means health care right across the spectrum, not just nurses and midwives or paramedics. We are looking at what we can do for allied healthcare workers and cleaners, who play an incredibly important role in our hospitals. We are also looking at the group of people who often get left out in this—our security officers. Our frontline security officers in our hospitals also need additional support, legislation and reforms in their area.

This is going to be an enormous change. Whichever party is given the privilege of being elected to government next year has to look at the independent data. It shows that our health system is in crisis because we have inadequately staffed it and resourced it and that has been exacerbated by a global pandemic. Never once have I said that the pandemic has not made an impact. But if members speak to frontline healthcare workers as frequently and as often as I do, they will tell members that they were going into this pandemic understaffed and under-resourced. The pandemic only highlighted and exacerbated existing problems.

I am saying to the Government that there is an opportunity now, with Labor's announcements today and on the weekend, for it to match it and that it will work on a similar reform. What I have heard from nurses, midwives, paramedics and allied healthcare workers is that, whoever is in control of the Treasury benches, they expect them to be focused on delivering healthcare services. That does not mean opening shiny new buildings. In fact, when members speak to frontline workers across New South Wales as frequently as I have, they will hear those workers are not interested in shiny new buildings. They are interested in developing the services that are meant to be taking place in those buildings. They want the services that their communities had previously but were taken away and replaced with shiny new buildings without adequate resources and staffing. What we said today and over the weekend is what we will continue to say: We will focus on making sure that we deliver safe staffing across our health system to make sure patients get the health care they deserve.

Mrs LESLIE WILLIAMS (Port Macquarie) (17:07:14):

I thank the shadow Minister and member for Keira for moving this motion in the House. I move that the motion be amended as follows:

Omit all words after "That this House" and insert instead:

(1)Between April to June 2022 New South Wales continued to provide high quality and safe care to community despite significant pressures as the New South Wales health system continued to respond to the impacts of the COVID-19 pandemic and the peak of the influenza season.

(2)Despite these challenges, the majority of patients started their treatment within clinically recommended time frames.

(3)The New South Wales Government is investing a record $33.5 billion in health as part of the 2022-23 budget and has clear plans and policies to continue to grow the public health system from strength to strength.

There is so much I want to say. I am confident that my colleagues, particularly the member for Oxley, will talk about the incredible investment in the health sector they have seen in the time they have been Government members. First and foremost, I have a question for Labor. I am wondering when will Labor tell the Nurses and Midwives' Association that it no longer supports nurse to patient ratios? When will Labor explain to them that, despite walking in the streets with them and waving banners, it is no longer listening to its members? It needs to be up-front with them. That is the first thing it needs to do. I encourage the shadow Minister to be honest about what his policy is.

As someone who was previously a nurse, I also genuinely ask the shadow Minister: What exactly does safe staffing levels mean? Perhaps he can answer my question in his reply speech. I will guess that the member for Bega will speak on the motion today. I encourage him to do that and if he can explain what safe staffing levels are, I am more than happy to take the answer back to nurses in my electorate, who I still spend a lot of time with. I have no doubt they will ask me what Labor means by safe staffing levels. My take on that is that it sounds very similar to nursing hours per patient day. Maybe I am wrong, but I am happy for him to correct me if I have misinterpreted his definition of safe staffing levels.

The shadow Minister made some interesting comments on his motion today. He talked about all of the plans that Labor has going forward if its members eventually get to sit on this side of the House. The Nurses and Midwives' Association will remember what Labor did when it was last in government. I am sure that my colleagues who will also speak on this motion will mention the thousands of beds and many maternity departments that Labor closed. In 2009 and 2010 I was working in the base hospital at Port Macquarie and I remember very clearly the announcement that Labor made. It announced it would delete 400 positions across the 23 hospitals in the North Coast Area Health Service.

The ASSISTANT SPEAKER:

The member for Canterbury will come to order.

Mrs LESLIE WILLIAMS:

Why? Because it had to service its $8 million debt. That is Labor's record on managing our health sector. Was the Health Services Union happy about that? Oh, my goodness, no. It made it very clear that local communities were going to lose out. And that is exactly what happened. Labor left our communities behind, closed the hospitals beds and deleted 400 jobs.

Dr MICHAEL HOLLAND (Bega) (17:12:20):

I support this serious motion moved by the member for Keira and acknowledge the comments of the member for Port Macquarie. I have the experience and privilege to serve in this place with over 40 years as a doctor. Over 30 years of this has been as a specialist in women's health, including obstetrics. The last 20 years has been in my electorate of Bega, which experiences the same disadvantages and challenges of rural, regional and remote New South Wales. One cannot overestimate the crisis that has developed in New South Wales over the past 12 years. I have lived the experience of the age of a clinically safe, sustainable and professionally satisfying health service. Why was it safe, sustainable and satisfying? Simply because our hospitals were adequately staffed by experienced doctors, nurses and midwives.

It is difficult for a person to appreciate the sense of isolation and stress dealing with a critical and life‑threatening situation hours from advanced medical and nursing support. However, with adequate staffing, training and professional support, those nurses and midwives performed a remarkable service to their communities. Then things changed. Through poor management decisions, reorganisation of services and deafness to their complaints, nurses and midwives became unsupported, overworked and under-resourced by the current health system. There was only so much that those highly trained professionals could bear. They felt desperate seeing the safety of their patients—who in rural areas are often our close neighbours—deteriorate.

Health professionals see their patients and the consequences of the failure of the health system as we do our shopping in Woolworths. We see them in the street. But our rural health workers cannot continue to act as apologists for the failure and neglect of a government. They know that, despite their lived experience, despite the evidence of poor outcomes that are ignored and despite their evidence-based proposals for workplace solutions, they are being used as virtual cannon fodder for a failed health system. A time comes where enough is enough.

The nursing and midwifery workforce is aging and cannot cope with the overloading of double shifts, extra shifts and weekend shifts. They leave the system completely or they look for more satisfying and less stressful employment in health. The younger nurses and midwives are thus left unsupported and beyond their clinical experience. Doctors who expose the deficiencies of the health system reluctantly withdraw services and move to other jurisdictions. Meanwhile, the health system is cobbled together with inconstant fly-in fly-out locums who cost the health service up to $3,500 per day plus travel and accommodation. Every day my electorate office receives submissions from constituents with terrible anecdotal descriptions of their experiences.

The ASSISTANT SPEAKER:

The member for Oxley will come to order.

Dr MICHAEL HOLLAND:

They break down in tears at their treatment. In the three hospitals in my electorate, up to 10 per cent of patients are leaving emergency departments without being seen or receiving treatment. We know that those patients often ultimately require admission instead of being treated and managed in a timely manner. The number of patients with critical emergencies being treated on time is down to 45 per cent. The response of this Government is, "We build, we build, we build." But, as in the famous Tower of Babel, those opposite build but they cannot make things work. They cannot make things work because they do not respect or communicate with healthcare workers who are abandoning the New South Wales health system.

AThe Emperor's New Clothes

As in the Hans Christian ndersen fairytale , we hear how wonderful and beautiful everything is. But the health workers and the people of New South Wales know what the naked truth is. It is chronic shortages of nurses and paramedics. It is bed cuts. It is record poor ambulance response times, emergency treatments and elective surgery rates. That is the failure of the New South Wales Government's health policy, which is the subject of this debate.

Mrs MELINDA PAVEY (Oxley) (17:16:43):

I acknowledge that the member for Bega had another minute to speak, had a prepared speech and did not address the fact that the maternity ward was closed under Labor in the area he worked in. You are still having to work a couple of days a week because there is such a GP shortage. You did not actually get to the guts of the issue like the member for Keira did. The fact is that we have some very big challenges in the health system because we do not work properly with the Federal Government to deal with the GP shortages and the specialist shortages. They are the issues that we face. The member for Keira actually showed some decency in this debate. You failed your community by not speaking truth in this debate and by using florid rhetoric, and that is a real shame because you have an opportunity to come into this House and actually improve health outcomes for the people of New South Wales.

Ms Kate Washington:

Point of order: I ask that the member for Oxley be instructed to direct her comments through the Chair. She is leaning across the table and casting all sorts of aspersions on the member for Bega.

The ASSISTANT SPEAKER:

I believe the member for Oxley was incited by interjections, but the—

Ms Kate Washington:

Which she was making floridly herself.

The ASSISTANT SPEAKER:

The member for Port Stephens will allow me to continue.

Mrs MELINDA PAVEY:

And I—

The ASSISTANT SPEAKER:

I do not need any assistance from the member for Oxley. I uphold the point of order. Comments should be directed through the Chair. That is a basic rule of debate in this Chamber. The member for Oxley has the call.

Mrs MELINDA PAVEY:

Through the Chair, I do apologise. I got passionate just then because I was also reminded of the time when Graeme Reeves, the butcher of Bega, was operating down there. Women were interfered with and treated badly, and a lot of people turned the other cheek. That was a big scar on the people of regional and southern New South Wales. I accept some of the comments from the member for Keira because he is right. We have some challenges in health, but I do not think it is a crisis. I think absolutely there are challenges right across the nation. We have staffing shortages in hospitals across Victoria, New South Wales, Queensland, South Australia and Western Australia. We are relying on nurses coming from overseas, taking them from countries that also need them.

We are also taking GPs from countries that cannot afford to lose them, like South Africa and Sri Lanka. In this nation we have one of the highest doctor-patient ratios of any other country on earth, yet doctors are maldistributed—so much so that the member for Bega still has to work as a GP in his community. In my community I have beautiful new hospitals in Macksville and Kempsey, but our emergency departments are being smashed by level four and level five cases that should be seen by a GP. But they cannot bulk-bill so patients cannot get in to see them. That is what needs to be fixed. We need to work with the Federal Government; I am not going to disagree with that.

The ASSISTANT SPEAKER:

The member for Swansea will come to order. The member for Canterbury will come to order.

Mrs MELINDA PAVEY:

I am not going to disagree that there have been mistakes in the past, but this is about the future and the work that we are doing with the new Federal Government.

The ASSISTANT SPEAKER:

The member for Canterbury will come to order.

Mrs MELINDA PAVEY:

We should be working together on this, which is what the member for Keira said in his speech today. He acknowledges that there will be big challenges. We have increased the health budget by 98 per cent in 12 years.

The ASSISTANT SPEAKER:

The member for Murray will come to order.

Mrs MELINDA PAVEY:

In 12 years, we have increased the budget by 98 per cent because we have had the capacity as a good government to do it. As the member for Port Macquarie said, in Labor's day we had to lose 400 staff on the North Coast because there was no money to pay them. We have increased the budget. Thirty years ago the health budget was about 15 per cent of the total State budget. As the member for Keira knows, we are now up at about 33 per cent to 34 per cent. We need to make fundamental changes and improvements, work with the Federal Government to help fix aged care and work with the disability sector because our communities have the solutions. We are working with communities and the Federal Government and getting more doctors and specialists.

For example, one solution would be for specialists to do their training via telehealth. Do members know what happens? All our specialists have to come to Sydney because that is what the colleges say they must do instead of being allowed to do their training via telehealth at a regional hospital. We lose our specialists because they are based in Sydney. They partner up in Sydney and then have real challenges getting back to the bush. There are opportunities for us to work in a bipartisan manner to deliver improvements, acknowledging that we have actually increased the health budget by 98 per cent over the past 12 years.

The ASSISTANT SPEAKER:

The member for Port Stephens will come to order.

Mrs MELINDA PAVEY:

Whatever government is in power will face the same challenges. Until we come together as a nation to deal with those challenges and get the doctors where we need them to work, we will continue to have these debates. We need to work together to solve these issues.

Ms SOPHIE COTSIS (Canterbury) (17:21:58):

First, I acknowledge the shadow Minister for Health and also the Labor leader, who over the past 48 hours have demonstrated, with the workforce in allied health, nursing and midwifery, the leadership that this Government should have shown over the past 12 years. The point of difference was demonstrated on Sunday when a very important announcement was made with respect to 500 paramedics in rural and regional New South Wales, which is in addition to an announcement today of 1,200 nurses and midwives. That is a positive outcome. I take the member for Port Macquarie back to the late nineties and early noughties when her Government—whichever party she belonged to back then—privatised Port Macquarie Base Hospital. A Labor government bought the hospital back from Mayne Group.

The ASSISTANT SPEAKER:

The member for Port Macquarie will come to order.

Ms SOPHIE COTSIS:

Let us not forget that a Labor government bought back Port Macquarie Base Hospital. Let us not forget that a former Minister for Health, Minister Skinner, wanted to privatise five hospitals, including Shellharbour, Wyong, Bowral and a couple more.

Mrs Leslie Williams:

You have no idea.

Ms SOPHIE COTSIS:

Yes, oh dear. It was this Minister who had to come—

The ASSISTANT SPEAKER:

The member for North Shore will come to order.

Ms SOPHIE COTSIS:

In the nineties, Nick Greiner and John Fahey wanted to merge and privatise, and they shut down hospitals. Remember the Western Suburbs District Hospital? They shut that down. They wanted to shut down Canterbury Hospital but there was a massive campaign. If we want to go back to the past, I will remind members opposite about the past. Port Macquarie Base Hospital was a disaster. The nurses and allied health staff there were striking because their representatives in government at the time let down the community. Go back and do a search. The Labor Party has a plan to fix the health crisis that has been caused by this Government.

The ASSISTANT SPEAKER:

The member for North Shore will come to order.

Ms SOPHIE COTSIS:

We have only to look at the emergency waiting times. Blacktown, Mount Druitt, Prince of Wales Hospital and now Sutherland—if I were the member for Heathcote, the member for Holsworthy or the member for Sutherland I would be very worried. The total emergency starting times are 49.8 per cent in this quarter. Nepean Hospital—if I were the member for Penrith or the member for Mulgoa, I would be very worried about their total emergency starting time of 39 per cent. Westmead Hospital—if I were the member for Seven Hills, I would also be very worried. If I were the member for Parramatta, I would be very worried about emergency starting times of 40 per cent. What is the member for Oatley doing on total emergency starting times? It is 44 per cent at St George Hospital and 68 per cent at Canterbury Hospital. What is the member for Oatley doing? A quarter of his electorate are going to Canterbury Hospital. He has done zero. He has not been advocating. He has done absolutely nothing. He should look at the statistics around what happens in the maternity wards.

The ASSISTANT SPEAKER:

The member for North Shore will come to order.

Ms SOPHIE COTSIS:

What is happening to the community that he represents in Penshurst, Mortdale and Peakhurst? He should be very careful. Let me tell members about the member for Penrith and the member for Mulgoa. What are they doing about Nepean Hospital? What is the member for Parramatta doing about Westmead Hospital? Have they looked at the latest Bureau of Health indicators in their areas and the emergency starting times, where people are turning up to emergency departments and not even getting a look-in because they have to wait more than four hours? I say to the people of New South Wales that they will have a point of difference under a Minns Labor government. On 25 March they have the chance to vote in a Labor government to fix the health crisis.

Ms FELICITY WILSON (North Shore) (17:27:10):

I acknowledge you, Mr Assistant Speaker, the member for Port Macquarie and the entire health service. The one thing that all members are hopefully on a unity ticket about is how grateful we are to our health workers and those in our health system. We have always known how crucial they are, but never more in our lifetimes have we experienced just how much than in the past couple of years. We know how much we need and value them, and we know how challenging their days are. We acknowledge and respect that, and we know that we need to keep working harder to have their backs. As a government we are working to do that. We would like to work with those opposite to help support the system, but instead they are playing politics.

There is a global shortage of staff in every industry, sector and geography, including within the healthcare system, which extends to the healthcare system in Australia. It is disappointing that those opposite want to carp on and moan about that. We cannot try to resolve a problem unless we understand it. If they are not going to legitimately and respectfully engage with the fact that there is a global and national workforce shortage, they are not going to be able to come up with solutions to address the problem. They talk about things like needing more nurses, doctors and paramedics—

The ASSISTANT SPEAKER:

The member for Port Stephens will come to order.

Ms FELICITY WILSON:

—but all they do is throw around numbers and the idea that they would do more. There is no substance to what they raise. There is absolutely zero substance. Instead of coming up with a policy and a formation behind how to generate the extra bodies with the skills that do not seem to exist, they do not put the policy work on the table to show how they will do it. That demonstrates the way that Labor members approach every policy. They are policy light. When they have the chance to make decisions in government—and we know that past performance is the strongest indicator of potential future performance—all they do is put out mis‑characterisations and then fail to deliver on promises.

What did they do when they were last in government? The member for Bankstown spoke about supposed comments about the Liberal-Nationals Government's approach to hospital investment. I put on the record that there have been record levels of infrastructure investment in the healthcare system from this Government compared to every other jurisdiction in the country, investment that Labor could only dream of. That is a fact that they cannot dispute. While it might have been a nice florid speech about what she thinks people's intentions were when potentially opening or closing hospitals, it was not based in fact. Let us look at what Labor did. John Hatzistergos promised a new northern beaches hospital. Morris Iemma promised that the Parkes hospital would be delivered and that Tamworth Hospital would be redeveloped. John Hatzistergos also promised the redevelopment of Wagga Wagga Base Hospital. We all know that Bathurst hospital was an abysmal failure by Labor. What did they do? They promised but they delivered zip.

Let us look at Labor's record compared to the Liberal-Nationals Government. Let us look at the facts. They do not seem to understand some of the facts. Some of those opposite are calling out about Royal North Shore Hospital. Maybe they could ask the member for Strathfield what he thinks about North Shore hospitals, because he lives in the electorate that Royal North Shore Hospital is in. I do not live in the electorate that the Royal North Shore Hospital is in, but the member for Strathfield does.

The ASSISTANT SPEAKER:

The member for Wollongong will come to order.

Ms FELICITY WILSON:

Maybe they should talk to him about what he thinks about his local hospital. I have experienced our local hospitals; maybe those opposite have not. I had a pandemic baby in a maternity unit in the redeveloped public Royal North Shore Hospital and got to experience the health care of our nurses and midwives. I was taken care of in an incredibly challenging time for our State, our nation and the world. I appreciate and respect that. I have family members who are nurses. I expect us, as a government and a State, to respect and invest in them. The only expertise on the other side of the House is in failure. The member for Swansea might want to think about what her government is doing—

Ms Yasmin Catley:

My government? I know what you're doing.

Ms FELICITY WILSON:

Sorry, her Opposition. I am sorry that she is are not in government. I know she was complaining about GPs and trying to blame us, but that is the responsibility of the Federal Labor Government. Maybe the member for Swansea could think about the constant promises she makes about ratios. The member for Blue Mountains constantly makes promises and waves placards. What did they think about today's non-promise from Labor? The notion of safe new staffing levels is a complete backflip on anything that those opposite say they support. Labor lies, obfuscates, makes false promises, delivers failures on what it promises and cannot deliver any outcomes for our community.

Ms Kate Washington:

Sit down!

Ms FELICITY WILSON:Time expired

We know that we are the only ones who can achieve it. I would also like to note— [.]

The ASSISTANT SPEAKER:

The member's time has expired.

Ms Felicity Wilson:

Point of order—

The ASSISTANT SPEAKER:

Order! The member for North Shore will resume her seat. Members will come to order. I would like to hear the point of order.

Ms Felicity Wilson:

Will the Assistant Speaker ask members opposite to respect the rulings from the Chair? I would prefer it if they did not shout out to me, "Sit down!" That is a ruling that only the Assistant Speaker can make. If you would like me to sit down, that is in your hands.

Ms Yasmin Catley:

To the point of order: To the member's suggestion that your rulings be listened to, perhaps she should practise what she preaches. The Assistant Speaker called her to order a number of times and she disregarded what was said.

The ASSISTANT SPEAKER:

I thank all members for their contributions.

Ms Felicity Wilson:

She is very cranky about me—

The ASSISTANT SPEAKER:

If the member for North Shore persists, she will be removed from the Chamber under Standing Order 249A. I will not put any member on a call, but I note that some members are already on three calls to order. Members will be removed from the Chamber if this persists because it is getting silly. Most members have breached the standing orders from time to time. I have allowed a little bit of latitude. I do not uphold the point of order. It did not add any value to the debate.

Mrs HELEN DALTON (Murray) (17:34:39):

I support the motion of the member for Keira and thank him for bringing it to the attention of the House. I am going to put a country lens on this debate because we have heard a lot from city electorates. The health system in the country has collapsed. It is not in crisis; it has collapsed. Doctors, nurses and paramedics are the front line of care and, as I said, the system has collapsed. Every day my office receives an email or is contacted by people about some sort of health issue. Most of the complaints I receive are from health workers themselves—bullying in the system, overworked health workers, underpaid, under-resourced and under-valued by this New South Wales Government. If the Government valued them, they would be looked after. Nurses from Griffith Base Hospital have told me the situation is out of control. They are so exhausted and understaffed that they fear unsafe practices could cost their professional registration.

The Government is putting them on the line. It is just appalling. No breaks, long shifts, patients waiting for hours and hours in emergency departments before they are seen—even sitting on the floor because there are no chairs—is just a typical shift at Griffith Base Hospital. No wonder health workers are leaving the job in droves. The NSW Nurses and Midwives' Association are calling for ratios of one to four on the floor and one to three in ED, and I proudly support that. The implementation of ratios would be the foundation for fixing a broken system, yet nobody in the New South Wales Government even wants to look at it. They head for the hills when ratios are mentioned. Why is the Government not listening to the people at the coalface about this problem—the nurses, the health workers? If they had better ratios perhaps they would not have to leave the industry. They are stressed, burnt out, overwhelmed and exhausted.

Access to rural health services has declined over the last few decades as administration has centralised and our towns have lost the ability to advocate for their own outcomes. In my electorate of Murray "community" has been taken out of community health. We cannot even help ourselves. Our local health district faces roadblocks and excuses. They have taken equipment from our local hospital and regionalised it to a larger hospital outside my electorate. We know that the further west we go, the poorer the health outcomes. Twenty years ago our life expectancy was greater than our city cousins. Today, it has been reduced by at least—and probable more than—five years, as services are continually stripped from the country and centralised.

Leeton, a town of 12,000 people that services a larger area, does not have a full-time permanent doctor at its hospital. The hospital only offers basic medical assistance. Our community does not expect brain surgery facilities, but it would be nice if we did not have to travel for hours after a game of footy to have an X-ray or to sit in an understaffed emergency department until the early hours of the morning waiting for a doctor to travel from another hospital. If people break a bone while playing hockey or netball on the weekend they go to Wagga Wagga. What happens? They are told, "Go back to where you came from. Come back on Monday and we will fix it up." That is hours and hours of driving that we have to go through. We should not be treated as second-class citizens.

If the member for North Shore wants facts, then more than 700 public submissions to the recent Rural Health Inquiry and 44 damning recommendations is a pretty good indicator. They are the facts that something is desperately wrong with the system. The Government has plenty to get its teeth into with those recommendations before it gets ousted next March. The inquiry ultimately found rural New South Wales has poor outcomes, inferior access to health and hospital services and it faces significant financial challenges. There are just so many things wrong with our health system and there is no single silver bullet. We must continue to listen to rural communities. We know what our problems are and we also know how to fix them. But we have been taken out of the conversation and those closest to the problem are the ones likely to fix it.

Mr RYAN PARK (Keira) (17:39:41):

In reply: I thank the member for Bega, the member for Canterbury, the member for Oxley, the member for Port Macquarie, the member for Murray and, surprisingly, the member for North Shore. It can be a trap in this place to read from documents provided by a ministerial office. The member for North Shore often is forced to contribute to these debates and today she has fallen through a few traps. One of the things she said was, "It's just about numbers". The Minister recently announced a pretty big number: 10,000 extra health workers over the next four years, and 7,000—a reasonable number—over the next 12 months. Labor is committing to 1,200 on top of that. The member talked about a recruitment problem. We do not have a recruitment problem in this State; we have a retention problem. That is very different. We are losing nurses. It is not a problem of recruiting; it is a problem of keeping them.

The member for Port Macquarie, someone who I respect in this place, who was a health worker in a former life, talked about what the policy involved. The policy is pretty simple, so I will make it very clear. This proposal will see the introduction of minimum and enforceable safe staffing levels into the Public Health System Nurses' and Midwives' (State) Award 2021, commencing 1 July 2023. That is an award those opposite should know.

The ASSISTANT SPEAKER:

The member for Port Macquarie will cease interjecting from her current position in the Chamber.

Mr RYAN PARK:

The changes will be implemented by converting the existing nursing hours per patient day staffing requirement into minimal and enforceable safe staffing levels within the public health system over time. We have said today, the nurses have made it very clear, they will continue to campaign against me, against Minister Hazzard, against others to try to pursue even further inroads. But reform starts with a first step. A journey starts with a first step. Today we have taken it. We have made a decision that the current staffing model needs to be improved. We have said that at the acute end we believe emergency departments are the ones most under pressure. We have to start in some part of the hospital. We understand this will be negotiated and done over time. We have not denied this, and we have not said that this will be done with a snap of the fingers. We never have. To sit here and say we are not prepared is wrong. To say, as the member for North Shore did, that it is about numbers is also wrong, given what the Minister for Health has also said. I thank again all members for their participation, particularly my colleagues on this side, including the member for Murray, who have been very strong advocates for their communities across the board, and particularly for those who live in regional and rural New South Wales.

The ASSISTANT SPEAKER:

The member for Keira has moved a motion, to which the member for Port Macquarie has moved an amendment. The question is that the amendment of the member for Port Macquarie be agreed to.

The House divided.

Ayes42

Noes38

Majority4

Amendment agreed to.

The ASSISTANT SPEAKER:

The question is that the motion as amended be agreed to.

The House divided.

Ayes42

Noes38

Majority4

Motion as amended agreed to.