Motions

Remote Area Attendance

Mr PICTON (Kaurna) (11:01): I move:

That regulations made under the Health Practitioner Regulation National Law (South Australia) Act 2010, entitled Remote Area Attendance, made on 16 May 2019 and laid on the table of this house on 4 June 2019, be disallowed.

This is a very serious matter and this house should be taking action very swiftly to disallow these regulations. As members would know, Gayle Woodford, a nurse in the APY lands, was tragically murdered in 2016—a nurse, who devoted her life to caring for others and who worked tirelessly to support that community, was taken from us.

Since then, an action campaign began here and around the country to improve safety provisions and legal protections for nurses who work in remote areas, with the central principle being that nurses and other health workers should never be alone. They should never have to feel like they have to respond to instances like that by themselves. There should always be somebody else with them to make sure they are safe in very remote areas of our state.

That was then followed up by legislation under the previous government and championed by the current member for Hurtle Vale and the former member for Elder, Annabel Digance, to bring in legislation that would enact Gayle's Law here in South Australia. I am very glad that was passed in the parliament back in 2017, and we have led the way in South Australia in bringing that legislation into being.

However, unfortunately that was not the end of the story. Unfortunately, what we saw following that were significant delays in implementing the law, in properly proclaiming the law so it could come into operation. Then the government, in a very devastating blow to so many people, brought in regulations underneath that law that weaken the entire premise of the law that parliament brought in.

The regulations the government snuck in, entitled the Health Practitioner Regulation National Law (South Australia) (Remote Area Attendance) Variation Regulations 2019, allow the principle that nurses should never be alone to be wiped away, because it allows a weakening of that law so much that if a risk assessment is done by a nurse then they are able to go by themselves to respond to call-outs. As people would know, nurses make risk assessments all the time. There is no doubt, particularly when you speak to Gayle's husband, Keith, that Gayle undertook risk assessments of that type all the time—and did on that night. That is why we legislated to say that nurses should never be alone.

This has sparked very significant outrage from the nursing community in South Australia, who thought this was a done deal, who thought that this was legislated and protected, but who have been devastated to learn that the government has sought to weaken this legislation. It has also been particularly devastating for the Woodford family, who thought that Gayle's legacy was now enshrined in law, that there was some good to come out of all the heartache that has happened to their family. Unfortunately, they have now had to speak publicly again to advocate for the original position they thought had been passed.

This was brought to the attention of members of our party and also of the government and the crossbench by the Australian Nursing and Midwifery Federation of South Australia. They originally raised these concerns with the government when they were consulted about the draft regulations. Unfortunately, the government decided not to take any action in regard to those draft regulations, and they proceeded through the legislative regulation process internally within the government without having concern for those issues raised with them.

They have now had to raise that with the opposition and the crossbenchers here and in the other place to try to get this resolved. In a letter from Adjunct Associate Professor Elizabeth Dabars, the CEO/Secretary of the ANMF(SA), they have raised concerns. They said:

You would know from earlier debate on this legislation that ANMF (SA Branch) has been a staunch advocate for change to the law that would prevent circumstances in which nurses or midwives working in remote areas could be placed in harm's way due to the absence of appropriate collegiate presence when responding to the healthcare needs of the community.

The law adopted by the parliament was premised on the existence of a second responder in such circumstances. The principle that nurses or midwives should not be asked or placed in circumstance that would require them to attend alone was embedded in the act. The second responder category was drafted in such a way that it was sufficiently broad to ensure it was capable of providing sufficient people that could undertake the role, necessary for the protection of the nurse or midwife.

We were therefore distressed to read the regulations, as gazetted, which create the possibility that nurses or midwives could be required to attend alone in certain circumstances. Such a possibility in our submission is fundamentally at odds with the intention of the parliament and campaigners for the legislation, including ourselves.

In essence, the regulations would permit the nurse or midwife to attend to a person in need of health care without a second responder provided that it was an attendance to a public space and where they have conducted some form of risk assessment. This creates, in our view, the very circumstances that have created risk of harm in the past.

We seek your assistance in moving or supporting disallowance of the regulations insofar as they create a circumstance in which a second responder does not accompany the health professional when responding to a call out in their community.

That is a very clear letter from the advocates for nurses and midwives in this state saying that the regulations this government has brought in are not good enough; not only are they not good enough but they undermine the very premise upon which so many people campaigned and upon which this parliament legislated to protect nurses and midwives in the first place.

The focus is not the entirety of the regulations; the focus is really on a particular aspect of the regulations, which is regulation 11D(2)(e) and one particular requirement, one particular loophole I guess, where they are saying that nurses can go to instances alone. There are a number of others that they have put in the regulations that I think most people are comfortable with and think are reasonable, such as if you are attending a police station or the like. But this one, 11D(2)(e), provides:

(e) where—

(i) the callout is to a place in a location for which there is a risk management plan approved by the Minister; and——

which could be a very broad risk management plan indeed—

(ii) the nature of the health services that, in the opinion of the health practitioner, are likely to be required at the callout are covered by or otherwise consistent with the approved risk management plan; and

(iii) the health practitioner has, in accordance with the policies and procedures under section 77H of the Act and the risk management plan, undertaken a risk assessment and determined that it is safe to attend the callout without a second responder.

So the premise is put on the nurse or the health practitioner to make that judgement about whether it is safe for them to attend the call-out. That is the very premise we were trying to address in this legislation. Not only has it concerned the ANMF and so many of their members but it is, as I said, very concerning to the Woodford family, who have been through so much over the past few years and had thought that they had achieved so much in the legislation passing this house.

Keith Woodford, who I have had the pleasure of speaking to a number of times over the past couple of weeks, spoke recently on ABC North and West radio about this. He was asked, 'Well, how did you feel?' He said:

We felt gutted and…devastated. If it wasn't for the Nurses Union who picked it up at the last minute a couple of weeks ago, we wouldn't have known that this regulation had been put in. It was all done and dusted a few years ago…I just can't work out why. The only thing I can think of is the cost and we've all racked our brains to work out why because that very regulation is what we were fighting against…I think it must be finance because they might have to…pay money during the day time as well. I honestly don't know…I've got no idea. All I know is that they've got other vested interests.

He was asked:

Do you think South Australian people would be happy to pay a bit more…if it meant that nurses were covered all the time by Gayle's Law, that they were never alone?

He said;

Yes, I think they would…even the people up in Fregon that I knew…they're all for Gayle's Law, the majority of the people. Life is different up in the APY Lands to the norm, they put up with a lot, violence and lack of work but then you look on the other side where jobs are available, they sometimes don't want to do it…this is not the majority of them. The majority of the people in the APY lands are lovely people…strong cultural life but drugs and alcohol come into it and boredom, not doing anything has got a lot to do with it. It's just…another kick in the guts. We just seem to be getting so many of them all the time…you think everything's…going well and then this happens...we didn't even know that regulation was going…to be in there, the statement that nurses were allowed to do a risk assessment during the day and if they felt if it was safe, they could go out by themselves, which was entirely against Gayle's Law. That's what Gayle's Law is, never alone, there's got to be a second responder there at all times.

He was then asked:

Is there any doubt in your head that this is something that Gayle would have done on a daily basis, going through and doing a quick risk assessment before making a choice?'

He said:

Yeah…even when people used to come to our house at night time, she would do a risk assessment through the…area before she would let anyone through…the door…people who would come here and they were drunk or on drugs, there's no way she would let them in, or if they looked agitated or violent.

This is, I think, pretty devastating. It is pretty devastating for all those people who worked so hard to get this legislation in place. It is devastating for the Woodford family, who clearly know the circumstances better than anybody. It is clearly devastating for those nurses and health practitioners who are currently working in remote areas of South Australia at the moment.

That is why the disallowance of this regulation is so important. That is why the government have the opportunity now to delete this particular offensive section of their regulations—the section that goes against the entire premise of Gayle's Law—and reissue the regulations without that section so that Gayle's Law can continue in the way that it was intended to, in the way that this parliament passed it and in the way that nurses, midwives and other health practitioners need it to be in place to protect them.

They are doing an amazing job. They are doing jobs that many of us would not want to do. It is so important for the people of our state that they are doing these jobs, but they need to be protected while they are doing them. We have a responsibility in this parliament to make sure that they are protected and we have the ability to do that today. I hope this parliament takes that action to protect those nurses and to make sure that this sort of tragedy never, ever happens again in this state.

The Hon. J.A.W. GARDNER (Morialta—Minister for Education) (11:15): I thank the member for Kaurna for putting this on the Notice Paper. I appreciate the way in which he presented his argument moments ago. I indicate that the government is taking this matter very seriously. I note that the member for Heysen this morning also listed on the Notice Paper the identical motion as a representative of the Legislative Review Committee.

When the Legislative Review Committee is considering a matter or a regulation, the process is that there is a time-limited period during which the parliament can disallow a regulation. When the Legislative Review Committee wishes to give it further consideration or, should they determine that, after consideration of a regulation, it merits disallowance, the practice is to put on the Notice Paper what is known as a holding motion. Once the holding motion is on the Notice Paper, then the time-limiting nature of a regulation before the house does not take effect.

I acknowledge that the limit on a holding motion from the perspective of a political party that wishes to oppose a regulation outright is that, if the Legislative Review Committee formally decides that it wishes not to proceed with the disallowance, the practice is that the representative of the Legislative Review Committee will withdraw that holding motion, which at that point would prevent the house from being able to disallow.

The Labor Party has a firm policy position, which I believe from the member's contribution is that they wish to disallow the regulation, to have it listed a second time, and the member for Kaurna has set out his reasons. I note in doing so that he has indicated that there is a part of the regulation which he objects to and which, I believe, has instigated the Legislative Review Committee's further consideration of the matter.

I understand that they are taking written submissions on that at the moment and are looking into evidence. I indicate that, while the government will be seeking to adjourn this motion at this point, we are taking the matter seriously. The Legislative Review Committee will continue to take those submissions, and we will reflect on those submissions in the weeks ahead. Am I able to move the adjournment or must another member do that now that I have made a contribution on the motion?

The SPEAKER: You can seek leave to continue your remarks.

The Hon. J.A.W. GARDNER: I do not seek to do that. I will conclude my remarks in case another member wishes to contribute. I conclude my remarks by saying that, in that spirit, I do not wish to comment on the merits of the motion, other than to say that the government is looking at it seriously. I anticipate that after a further contribution from the member for Hurtle Vale a government member will seek to adjourn the debate and we will continue to take it seriously in the coming weeks.

Ms COOK (Hurtle Vale) (11:18): I rise clearly in support of the member for Kaurna's motion that we should disallow these regulations for Gayle's Law, principally based upon the one section of the regulations that would allow a nurse working in a remote environment to undertake a risk assessment and then work as a sole provider of services without any accompanying support.

From the moment that we heard the news about the terrible circumstances around Gayle Woodford's death, I felt very deeply connected to the situation and speak in this place probably from a point of difference from most in two ways. Firstly, I clearly have a very deep clinical level of experience from being a registered nurse working in a variety of settings making risk assessments and so have an informed and evidence-based approach to the decision-making here.

From that point of view, if I was just to make a very simple statement, when you are a clinician of any kind, be that a registered nurse, a carer, a medical practitioner or an allied health professional, the vast majority of people who enter these types of professions are caring professionals. People do it because they do not want to see people suffer. They want people to live the best possible life, and they provide whatever care, support and level of clinical expertise they can in order to achieve that. Knowing the types of people who would particularly be working out in the lands, they are very special clinical practitioners. These people have a very deep sense of social justice and will do anything they can to ensure that the best possible health care and service delivery are provided to those people.

In doing that, yes, often they will need to make risk assessments multiple times during the day at different junctures when they are provided with opportunities to deliver care. Should they be the people who are left to make that decision at any time on whether or not they travel independently to a destination to deliver that care? I say no. I say the people who should be making that risk assessment and that decision are the managers—the managers of the service, the people who are providing the funding, supports and resources to deliver those services. They are the people who should be making the decisions and, in the main, that then comes back to the government that is setting the rules around that.

I believe that the risk assessment can be done now. We know that there is an enormous risk to life and safety for anybody travelling independently out into the field to deliver care, principally women undertaking nursing roles in remote communities. We know that there is a risk. What cost do we place on life and that risk? There is no cost, which brings me to the second level of difference I have from an experience point of view, and that is the sense of immense grief and loss you experience when you lose a family member in a violent, fruitless and hopeless situation.

That is the sense of grief and loss that the Woodford family has. It is the sense of grief and loss that her friends and her work colleagues have—the hopeless waste of life that has happened to somebody who was absolutely dedicated and committed to ensuring that people on the lands had the best possible access to health care and support.

If anyone does need a reminder of what that grief and loss might look like, I invite you to look at the vision of Julie Kelbin, the mother of Jack Hanley, who lost his life in Hindley Street. However that event came about, whatever happened, the image of Julie and her absolutely guttural cries should be enough to remind you of what is absolute waste. That is what has happened to Gayle Woodford's family. This is what we can stop with the stroke of a pen.

We can say that no nurse, clinician or provider of care, love and support in a rural setting should be asked to make, by themselves, an assessment when begged by somebody to come and help at any time of the day. We can make that decision. It is a simple stroke of a pen. Please support us in our call. I sense that there is definitely a deep understanding on both sides of the chamber here of the hopelessness of the situation that people face, and I urge you to support this motion.

The Hon. D.C. VAN HOLST PELLEKAAN (Stuart—Minister for Energy and Mining) (11:25): I move:

That the debate be adjourned.

The house divided on the motion:

While the division bells were ringing:

The SPEAKER: Members, please be advised that I have allowed a photographer in the gallery.

Ayes 24

Noes 21

Majority 3

Motion thus carried; debate adjourned.