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House of Assembly - Fifty-First Parliament, Third Session (51-3)
2008-10-15 Daily Xml
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NURSING AND MIDWIFERY PRACTICE BILL

Second Reading

Adjourned debate on second reading (resumed on motion).

(Continued from page 412.)

Ms CHAPMAN (Bragg—Deputy Leader of the Opposition) (16:03): Before the luncheon adjournment, I was referring to the training impositions of this legislation on people in the nursing profession who leave the workforce for a period or stop undertaking their professional duties, and the onerous requirements and lack of recognition. In fact, the imposition, after certain periods, of the requirement to redo the whole degree. That is alien to any other profession in South Australia. I do not know of anywhere in Australia where that is required. That is unacceptable in respect of the academic qualification and its recognition for nurses.

Members interjecting:

Ms CHAPMAN: The interjections indicate that there is a requirement in respect of non-registration to reregister. What happens is that people keep up their registration during the course of their time. In fact, let me give you an example. The previous member for Hartley (who, of course, will soon be back here as the next member for Hartley), Mr Joe Scalzi, remained a teacher during his glorious time in this parliament. As a registered teacher, he remained a member of the Australian Education Union throughout that time and, indeed, upon his leaving the chamber in 2006, was snapped up by Glenunga High School and resumed his teaching duties without requiring a shred of re-education after a decade of service to this community.

The interjections are patently wrong. I think it is important to understand the distinction between a discontinuance of registration and a discontinuance in relation to undertaking the professional duties during a period of time which introduces this imposition. I want to make that position absolutely clear. No other profession completely nullifies, effectively, the recognition of a prior degree as does the process for nurses.

During the debate this morning, I received a further response to the invitation to make a submission that the opposition had presented. In terms of this issue, I mentioned that one of the parties consulted by the government and, indeed, the opposition, was the Maternity Coalition of SA. During the pre-luncheon debate I received a response from Ms Lareen Newman, who is the state president of the Maternity Coalition and a member of the organising committee of SA Birth Matters, both important organisations in respect of the advocacy for and aspirations of those in the midwifery profession, soon to be recognised in the title of this new legislation.

I will tell the minister (and I am sure he will be pleased to hear it) that they endorse the addition of their name in the title. They like that idea—not surprisingly—and we, of course, support it. They are also pleased to have a dedicated midwifery-trained person on the new board, and that is great. We expect that they would support that. But here is something very interesting that just demonstrates what I was referring to prior to the luncheon adjournment, that there is a lack of genuine consultation and even feedback to the relevant stakeholders on this issue. She states:

I also thought that the original draft bill introduced prescribing rights for midwives, although, despite repeated readings, I cannot see this in the current version.

This tells us a number of things. One is that, in previous versions, there was an attempt by the government to introduce prescribing rights for prescription drugs for members of the nursing profession; in particular, this representative is referring to midwives. That tells us the first thing, which we knew.

The second thing that it tells us is that, on the day that we are debating this bill, an important advocacy representative group, in this case midwives, does not have a clue about the fact that this issue has been dumped from this bill—not a clue. In fact, she is still rereading it, trying to find it. She cannot understand why it is not there; nobody has told her.

Now, why would that happen? I can tell members of the house why it would happen. It is because the government does not want to have any trouble with this bill going through. The government wants to get this bill through. It has done a deal with those who oppose prescribing rights for non-medically trained people to ensure that this bill gets through.

I state for the record that the opposition's position has been and remains that a non-medically trained person should not have prescribing rights for medication. There are a number of reasons for that, and I do not need to go into them for the purposes of this debate. Suffice to say, that is something for which the opposition believes there must be specific training. There is specific training, for example, for nurse practitioners to undertake some of those duties. They have training for that, and their training is acceptable to the opposition. They have some power to administer drugs, but the prescription of drugs by a non-medically trained person is not something that is endorsed or supported by the opposition.

But, we are honest about it. We tell people, when they are lining up to seek recognition for this and for the opportunity to do it, what our position is. We do not do a deal with the AMA or any other body which says that we oppose this and then drop it out of the bill. We tell them the truth.

The Hon. J.D. Hill interjecting:

Ms CHAPMAN: Interestingly, the minister interjects to suggest that there is some reference in the act to cover this. When we conferred with the AMA this morning, we found that its understanding is that there is no change. In my office last week, it was confirmed by members of the department and, indeed, the Chief Nurse, that there is no change to the law which currently provides for the distribution of drugs other than in the Controlled Substances Act, and that is simply replicated from the Controlled Substances Act in this bill. One would ask, 'Is this necessary?' We do not take objection to whether it is repeated on the undertaking that has been given to us that there is no change to that application as to who can do it, under what authority and what qualifications they require. That remains the same. That is what we have been told and, if it is not the truth, we want to know the truth. I have no reason to disbelieve it. Interestingly, that is why the Maternity Coalition said to us (it came through at 11:56 this morning) that it could not find the section in the bill.

This bill has now been out in the community for some time and, not surprisingly, the relative stakeholders have quite properly negotiated and put their best position, and the government has come up with a draft that it can live with. The honest thing to do is to say to the stakeholders, 'This is the decision we have made,' not conceal it. That is what is not acceptable. In fact, we agree with the government's decision. It is entitled to make a decision and bring into this house a bill that it considers is in the best interests of the people of South Australia. However, let us be honest about it. That is what the minister failed to do throughout the negotiation stages of this bill, and that is not acceptable to us.

I feel very disappointed for those stakeholders who have taken the time to put in their submissions and who have been sold down the river on what they want. At least have the decency to have the person making the decision about what comes in or out of this parliament—irrespective of whether or not we fiddle around with it—tell them the truth about what is going on.

Interestingly, along with the debate and the public statements that have been made on this question of the expansion of personnel who may have the right to write prescriptions, there have been statements made on this legislation by various players at the South Australian level. Will they get extra rights or not? There have been comments by the AMA state president and the like, all putting their particular case. We also have a new player on the health legislation scene and that is, of course, the new federal health minister, the Hon. Nicola Roxon. She made a statement about this. That dried up pretty quickly, but her statement (made on 11 June 2008) was that she wanted to move to ease the workload of doctors by enabling nurses to be given the power to not only write prescriptions but also to make diagnostic tests. She was out there publicly making that statement.

Well of course that was, probably predictably, received like a ton of bricks by the President of the Australian Medical Association, who said that it would put patient safety at risk. There were a number of other statements made about it, but in essence there has been silence. We have not heard about that issue again from the federal health minister, and it seems the issue is dead for the moment. However, be under no illusion; that is what some people wanted. Quite reasonably, the government considered it and rejected it, but it failed to be honest about transmitting that to the very players who had made a contribution. I suppose it could say, 'Well, they'll see it in the paper when this bill goes through; they'll soon know when it's law, and that should be good enough for them.'

The other matter I want to raise on the issue of training, before I leave that third topic, is that there is also a difficulty for nurses who are training and who work in country regions. Another case that came to me this year related to a graduate registered nurse who resided at Tumby Bay on the West Coast. The member for Flinders—excellent member that she is—brought this matter to my attention, because this was a situation where a recently graduated nurse—who had successfully completed her three-year registered nursing degree at the Whyalla campus of the University of South Australia (highly regarded in this field) and who was registered with the Nurses Registration Board—was not able to get a position because there were very few nurse graduate positions available. Now, until she had done her six months' experience in a hospital she could not be employed as a nurse without being fully supervised.

Again, this highlights the reality of what is happening with a number of people coming through who have been encouraged back but who cannot get a training spot, and who are therefore unable to be accepted into the workforce, which is in urgent demand of them. They can undertake lower level duties or supervised level duties, but that means that they are not being used to their full potential. Interestingly, a number of statements were made in relation to funding to assist nurses to graduate, but nothing seems to have been done to deal with this question of training.

So, we have this training placement issue and this retraining imposition, and at the moment we have what appears to be an overburdened Nurses Board lacking the resources to process—and an inflexible ruling as to the applications process—applications from overseas-trained nurses, and we have received many such applications, which we welcome and which we need. So, I think the government needs to look at that issue.

I move now to the provision of the fit and proper person clauses, as they are sometimes described. This is a requirement now for any health professional who wants to treat a patient, whether they are registered or enrolled under the act. To be eligible for registration and, indeed, to remain registered, they have to report any incidence of medical unfitness or unprofessional conduct to gain that registration—that registration, remember, being the access prerequisite for them to practise their profession. The provision is quite lengthy and it imposes significant financial penalties of some $10,000 if you either fail to, or fail to adequately, report either of these two things. There is some detail, but, with respect to guidance as to what medical unfitness or unprofessional conduct is required to be disclosed, that is absent in the definition of the act. So, we have this general sort of fitness.

In principle, the opposition agreed, and remains in agreement, that for the medical profession, which currently has this requirement, it is appropriate, and that it is also appropriate that a standard be imposed to ensure that, in the case of someone who wants to undertake work as a nurse in the treating of a patient (that is, someone who is employed in a ward or a surgical facility or the like, rather than in an office or as an adviser to the minister or whatever), a standard must be imposed. The process that is proposed by the government, which is consistent, to some degree, with the medical profession obligations and is also monitored by their professional board, is a self-disclosure. When you have self-disclosure, the very least that should be provided is some guidance as to what you are expected to disclose. Sadly, there is not much help in the bill as to what that comprises.

If I were a newly graduated nurse and I was applying for registration, I would expect that, if a registration regime was in place with this condition that was necessary for me to comply with, I would want to be able to go somewhere to get some guidance as to what I am expected to disclose. One condition that is commonly referred to is that an applicant may have a communicable disease (say, HIV), and they are applying to be registered to be able to undertake treatment of a patient and there is a risk (and, quite obviously, in this example a serious risk potentially) that a patient or patients may contract that condition, which would be undesirable. That is an obvious situation and I think it would be hard to imagine that someone applying to be a nurse would not understand and appreciate that it is necessary to disclose. That is pretty obvious.

However, what if they have had some other sexually transmitted disease like chlamydia or gonorrhoea. What if they had had unprotected sex in the last 20 years and they do not know if they are HIV positive? What then is the obligation on the applicant to disclose their own sexual history? These are the sorts of things that the applicant should be able to have some guidance on as to what the level of expected disclosure should be.

There are other obvious things. If someone has a medical condition (not a contagious disease but, for example, a serious muscle problem) and their strength was significantly less than that of the average person, if they were to undertake nursing duties, as in the treatment of a patient, and they were so weakened by their own disability that they could not actually lift anything other than a piece of paper, it seems to me to be logically something that they would disclose. It would be clear that, if the board decided that they were still able to undertake nursing duties, they would not be expected, for example, to handle a patient on their own or to, in any way, be responsible for the lifting of a patient unaided. Clearly, they would not physically be able to undertake that duty.

This is something that, surprisingly, I cannot get any information about. Who is going to provide this information? Who should provide it? What are the guidelines going to be? I am a little surprised, to be frank, that the Australian Nursing Federation has not raised this or has not started preparing a list itself to try and identify what would be reasonable to educate its members, or prospective members, as it is a significant player as an advocate on behalf of members of the nursing profession.

I think it is important that we have some guidelines here. The ANF may say, 'It is not up to us. It is really a matter for the board. If the board want disclosure (which is imposed on them as a result of this legislation) then it should come up with a list of guidelines, or the department should prepare a draft, or somebody.' All I am saying is that it is unreasonable to expect this as a new imposition unless we have some indication as to what it is. Let me say for the record that there are big penalties here if you do not comply, if you do not disclose matters and make things absolutely clear. I say that is important. For all those who are lining up to be registered or to maintain their registration, this is very important.

The fifth matter I wish to raise is what I describe as the demotion of the mental health nurse. What is proposed in this bill, as I understand it, is that we are to have a register of nurses, both registered and enrolled, a register of nurse practitioners, and a register of midwives. At present the annual report tells the parliament every year how many enrolled nurses there are, how many general nurses (that is the description used), how many mental health nurses, midwives and nurse practitioners.

However, we are going to move to a model where a nurse has an asterisk next to their name, as I understand the process, to identify whether they have a specialty. It is fair to say that we have developed a number of areas where nurses have their initial qualification and then obtain other experience and recognition—for example, as a cardiac nurse or an aged care nurse—which is commensurate with and in recognition of their experience in the profession, but it is not specifically an extra qualification.

Mental health nurses are going to be put on a list which tells us that they are a nurse and then somehow or other we can identify, by looking at individual ones, whether they have a mental health qualification as well. Bear in mind that mental health nurses do another year of qualification after their nursing qualifications to become a mental health nurse. This is not some add-on. This is not six weeks down at Glenside campus for on-site work and then they return. This is about a significant extra qualification.

Since at least 1999—it may have been before but I am reading the current legislation which is the Nurses Act 1999—they have had that recognition. We know, for example, that of the 28,000-odd nurses that we have registered in South Australia 1,738 are mental health nurses. These are the special nurses who have this qualification. One of the reasons that it is important that that data be available, not just to us, but also to governments, is to allow us, along with any stakeholders who are interested in mental health and wellbeing, to appreciate that, arguably, mental health will be one of the biggest health demands of the future, and we will have a ready identification of the current workforce and be able to make some assessment of what will be needed in the future.

Let me give you an example of why that is so important. At present, the current Labor government proposes to undertake a redevelopment of the Glenside Hospital campus and, arguably, a significant number of mental health nurses are the people who make that campus in the professional contribution that they make in managing some of our sickest and most challenging patients in terms of behaviour who require help. From memory, about 10,000 South Australians a year access mental health services. There are 800 regular clients and patients at the Glenside campus, so nurses are significant players. It is the only stand-alone campus for psychiatric services in South Australia where they undertake their role.

As a result of the government's announcement, it is proposed that about 56 aged patients (that is, over the age of 60) who currently reside at the Glenside campus are going to be relocated to other facilities. There is a bit of controversy about where they will go: who should go to specially dedicated pods built at aged care homes while others go back into the community. Some will be put into dementia wards within existing aged care facilities. That is fine to the extent that, if the psychiatrists for these patients and their family support and agree to it, then that can happen over a period of time.

However, one of the issues that has been proposed by the government in transferring these people off the campus is that wherever they go they are going to be supported by mental health trained nurses; they will have access to that specialty service that they have now. So, if a specially dedicated pod for six or eight people is built next to a nursing home, it will be staffed by mental health trained nurses, not by registered nurses who are not mental health trained, not by someone who has done a six-week aged care course, but by psychiatrically trained nurses.

One of the reasons this is so important is because these people do have very special needs over and above issues of frailty and physical deterioration as we age, those who are now in aged care facilities and nursing homes who are very much at the frail-aged end of the market, and therefore because they have these special needs, it is particularly important in the protection of staff if they do not know how to manage them, and of the safety of other residents in aged care facilities.

Mental health nurses say to me, 'We are really concerned about this issue. We are concerned that there may be an attempt to have non-mental health trained people undertake those duties.' Now, I hope they are wrong, because we are going to have a seriously dangerous situation if that is the case. It is terribly important that we get this right.

I am now (proudly) the shadow minister for mental health as well as health, and I think that this is one of the huge challenges of health for our community in the next couple of decades. The minister has raised others, obesity of children, heart disease and so on, and there are a lot, I grant that, and I accept what he says in that regard, but mental health is way up there and we need to understand that we are going to need very specially trained people to look after them. That is the current ones, let alone the future demand that is there.

What I do say is that I do not think there is any reason why mental health nurses should not be retained in the data reported to us annually in recognition of that. I think that is terribly important. One of the reasons given as to why this is no longer necessary, and that they can slip off the list as a dedicated group, is because there are these other areas that are developing in their specialty, and this is no disrespect to those at all, but there are not any of them yet who have the level of qualification separately to mental health nurses.

In the categories, I think, of some 60 that has been explained to me of different areas of speciality and experience that are recognised, and that is great, but we should not be pulling down mental health nurse status, removing them from a dedicated area and yet at the same time saying we are going to recognise midwives, whom we totally support, to be elevated to having an independent qualification.

The nurse practitioner, and there are only 28 of those, are extra qualified. They have to have a certain number of years experience and other qualifications before they are actually approved to be practitioners. They are higher skilled in that regard and they are quite appropriately recognised and retained separately in the act for the register of those, so I do not see any justification for their demise.

When I have asked them, and other associations that represent them, they say that they have been told that with the national registration of nurses proposed there is going to have to be some sort of consistency between the states, and that if we all fall into line with this, as some of the other states have done, then we would be consistent with them, and this would be easier for the purposes of the national registration proposal. Well, we will not hold our breath as to when national registration might come in, but that is another issue.

The point I make is this, if we have a system that is good and we have a system that is better than another state, and I understand Queensland is also in the same position where its mental health nurses are not too happy about being pulled off the list, if we and Queensland, not that we have much in common very often, have a system that is better than the rest then we should be advocating that they change, not us. Let us bring them up to the standard to recognise this and be able to advocate that.

We are not going to hold up the bill because of it, but what I do say is, if the minister presses this registration, which frankly is an electronic registration, and it is not that difficult to have this kept as a separate register, I would ask that the government agree to at least request that the board provide us with a breakdown in the annual report—it will not be imposed on the legislation to do it because it will have a new register arrangement—and that we be given that information, because I think it is very important information.

Another matter I raise is that, when I have raised this previously with organisations, including the Australian Nursing Federation, one response that I have received is that, whilst it has not specifically indicated to us that it wants us to move any amendment or the like, it has highlighted to us the concerns that it has for the vulnerability and exposure of our current mental health workforce in their current working conditions. I raise this because I think it is terribly important that the board ultimately understands the importance of recognising the specialty.

Recently the ANF itself conducted a survey of all the mental health nurses who are members of that union. I assume that a mental health nurse working at Adelaide Clinic, for example, was not involved in this survey. It states that the findings show of these nurses that:

They are placed in circumstances which do not allow them to provide quality care to clients, they are frequently exposed to bullying in the workplace, nepotism is a feature of the organisation in which they work, they are not consulted over directions of the mental health system and are ambivalent about the direction of the reform agenda.

They are the very damaging survey results of the Australian Nursing Federation, and this is the issue which I think highlights the importance of understanding that this part of our nursing workforce is under huge pressure. They are clearly crying out for help. They are saying that their situation is not being adequately addressed and that they are very concerned about it, obviously. In fact, the Australian Nursing Federation is also concerned about this. We have an ever-expanding demand for the services of mental health nurses, and this is not confined to someone who might be working on a mental health ward—C3 at the Royal Adelaide Hospital, at Glenside Campus, at Cleland House, Margaret Tobin Centre, ward 17 or ward 18 at the Repatriation General Hospital. These are all services where our mental health nurses are under pressure. That is why it is so important, and they need help and they need support.

In addition to those services, of course, we have community nurses who are carrying a huge burden as well, because they are dealing with an even bigger number of people in the community who need mental health support with what are pretty much inadequate services. Coupled with the lack of suitable housing for many of our mental health sufferers in the community, it is a big problem.

I also bring to the attention of the parliament one of the initiatives of this bill that was referred to in the minister's contribution—which I raised during briefings—namely, the expansion of the corporate providers' liability. I think some slightly different rules will now apply to the corporate providers, the service providers. This may be answered in due course by the minister and I will raise some questions in committee as to who it applies to, but I assume that this is any private hospital that employs them, any aged care service where they are employed, or a nursing agency that provides on a daily basis thousands of nurses, personnel or professional people under this category in public health facilities.

I have mentioned the fact that, from our consultation with the private nursing agencies, they have not been asked about this at all. However they say, in general—and I will not go into all the detail—that they do not have a problem with having an obligation both to retain information (keep records) and also to provide that information to the board. There is some provision in there for an indemnity in relation to loss. That is all contained in clauses 39, 40 and 41. We will ask the minister to clarify that, but assuming for the moment that this requires some bookkeeping on the part of these providers, my understanding is that, from what they have heard about it, they do not have an objection to that and they fully support the registration system of the professionals and the obligations for nurses and carers, for example, to have their police checks.

They also have very significant obligations in respect of insurance for their liability at an occupational health and safety level when their agency nurses are undertaking work in a home, hospital, or other service. They do not have a problem with that. However, it highlighted to me that there is this aged care industry. We do not have direct control over the funding of it. That is a commonwealth funded service in Australia. As a state, our state health department has responsibility in respect of a number of aspects. One of them is the qualifications of the people working in them. The nursing and carer employees in these services are very important.

Obviously, most of our nursing home clientele are the frail aged. Some of them are middle aged and/or younger because they suffer from early dementia or conditions which, as there is no other specialty service for them, means they are placed in an aged care facility, but largely they are the mature aged and frail. Some are still ambulant and some are bedridden. The qualification for nurses, both registered and enrolled, is well-known and that is obvious. The qualification for aged-care carers is an aged-care certificate. For example, I think a Certificate III is a 12 to 16 week full-time course—and that varies depending on the institution—or you can undertake a TAFE certificate course for a year. I may be wrong on the exact detail, but it is significantly less than what nurses (registered or enrolled) undertake.

They do many things in nursing homes, not the least of which is having the physical care of many people who are either impeded in their mobility or sometimes completely immobile. One of the important functions which they tell me they do to ensure the health of the residents is to regularly turn residents who may be sitting in a chair or a bed. It is important to relieve pressure to ensure that they do not get irritations, bed sores, or other things. I do not know all the medical aspects, but it seems logical to me that, if someone is bedridden, in a wheelchair, or the like, this is something which they have to do. They have to fill out forms to say that they have done it regularly.

One of the qualifications or criteria that is necessary for aged-care facilities to qualify to have their accreditation under national rules is to ensure these things are done. They fill out these forms saying, yes, they have turned Mrs X every quarter of an hour, and the box has been ticked. I am sure the minister also gets this information from time to time—I get it—where an aged carer will say to me, 'Look, we're under such pressure in the aged care home that we actually don't always have time to do that but we still fill in the box.' That rings some significant alarm bells about the integrity of the process of managing the supervision of this, of course.

It is concerning when—fortunately, on a fairly infrequent basis, but, sadly, once is too often—we hear of the death and/or a circumstance in which someone who is in a nursing home suffers. That is always a tragedy. The fact is that carers, apart from having police checks and apart from having a certificate, do not have to be registered. As I understand it, the public therefore does not have the same umbrella of protection, for which this whole structure is designed, namely, to protect them against bad nurses; that is, a whole registration process, the capacity for a board to discipline, to impose conditions, to suspend and to de-register, as a punitive process to make sure that we weed out any bad or non-performing staff.

And it is not just nurses; of course, there is a whole myriad of other health professionals. We do not have this service at all for the protection of the public, which is what this is supposed to be all about, in respect of carers. You can not tell me that carers are any different to any other group in the community. There will be a few bad ones. There will be a few who actually do not do the right thing, and yet they do not have any structure upon which they can be held accountable. I am concerned about that because it is not just in aged care homes that these people are working. I want to be absolutely clear so that the house can understand this.

I have been informed of one case where a public hospital has rung an agency early one morning and said, 'We really urgently need 12 registered nurses.' That would not be unusual, obviously, because sometimes people do not turn up to work, and in big public hospitals especially this is a regular occurrence. During the week I was told by one agency that the day before his agency was unable to fill 200 applications for a nurse or carer. His estimate was that half of those were for nurses in public hospitals. We do not need to argue the point of that, other than the fact that it is a reality that we have to rely heavily on agency nurses at the moment, and it is a multimilliondollar expense for state governments to provide that in public hospitals.

The point I make is this: he gets this call to seek 12 registered nurses. 'Sorry, we just don't have them. We don't have them available to provide for you.' And this is 8 o'clock in the morning. At 9 o'clock he gets another call from the same institution which asks, 'Well, can you send 12 enrolled nurses?' 'Sorry, we don't have any enrolled nurses; we just cannot fill this with you.' Obviously, they ring around other agencies, and nobody is there. Come 10 o'clock he gets another call, 'Look, have you got eight carers?' Hospital services employ carers to provide for what I reasonably (I think) suspect is a safety and surveillance job in a hospital, to hold the fort together in a circumstance where there is an inadequate level of staffing.

When I made further inquiries about this particular case—and I have no reason to believe that that is unusual—I was told that this in fact happens quite a lot. It happens in public and private facilities where there is no registered person available. When I covered education we often had this issue in relation to child-care centres. If you could not get a qualified person to do something, you then had to line up to the minister and get exemption as an organisation in order to have more babies than the allowed formula to be able to have an non qualified person to do that, so there is a procedure to undertake in order to do it.

The process that is clearly being undertaken by public and private hospitals under pressure to obtain agency staff as its backfill is that, when there are not enough of them, of the qualified variety, they move down the ladder. Many would argue that at least they are not leaving patients unattended. Even if they are bringing a carer into a ward of four or five people at a major public hospital, at least they are there and are sufficiently trained to be able to identify when a patient becomes distressed or turns blue, or there is something that requires a trained person to immediately attend to them, and, if necessary, call in other high-level support—equipment or medically-trained personnel.

It is happening. These people are working in our hospitals, they are working in centres of acute medicine, and they are providing a service to people in an acute state. If this is legislation genuinely designed to protect the public and not just another registration procedure that costs money, if this is a process that we are to undertake in order to maintain the safety of the public, then I ask: why are carers not included? They are in increasing demand, there are many more of them, and we know that they are undertaking at least de facto surveillance in acute services. That needs to be attended to, given that this level of professional training is far inferior to that provided through a degree or other training offered to registered or enrolled nurses.

It is not acceptable that we allow a situation like this to prevail, even if someone says that it is a cheaper way of providing a workforce. I do not think a serious government could, in all conscience, follow that regime. However, it does concern me that this is occurring.

I am told that Certificate IV carers need an extra 12 weeks. There is a question regarding whether we should be encouraging the training and graduation of Certificate IV carers because, as I understand it, they can give some medication to patients—not prescribe it, but at least physically administer it to the patients. I presume that means handing them their pills or putting in a drip or something; it may just be that they can hand out pills or fill in records regarding medication that has been administered. However, if we have to rely on less skilled people then we need to have clear rules about what they will do in our acute services and we need to have a clear understanding about what supervision they will receive. At the moment we have a de facto system, which can only be a recipe for disaster if we do not deal with it.

The next matter to which I wish to refer is the purported attempt to introduce more transparent and accountable reporting of the board. My understanding is that back in 2004 (it may have been the former minister) a review of the Nurses Board was authorised. It was a Statutory Authorities Review Committee inquiry into the Nurses Board chaired, I think, by the Hon. Bob Such, the member for Fisher. In any event, it provided a final report in 2005, and in 2006 the current Minister for Health provided a response to that report—in particular in response to the recommendations made by the committee. There were many recommendations, but recommendation 5 stated:

The Nurses Board include in the curricula a stronger practical component of the university undergraduate courses, leading to a higher standard of nursing and a decrease in the shortage of nurses.

There was quite bit of information in the minister's response and, as it is on the public record, I do not want to waste time reading all of it. He said:

The evidence does not indicate that hours of practical training can be directly related to competence, and the MBSA is seeking to have competent graduates present for registration. The linkage of hours of practical training in an undergraduate program to a higher standard of nursing and a decrease in the nursing shortage would appear to be tenuous and unsupported by research.

That was his response, and he may be absolutely right. He then goes on to say:

The following recommendations [in respect of this recommendation] are largely or wholly outside the legislated role and function of the Nurses Board.

He refers to recommendation 1, which is about offering a Bachelor of Nursing course at the Warrnambool campus of Deakin University. That is not relevant for the purpose of our debate, so I will move to recommendation 2, as follows:

The minister extend the number of TAFE nursing cadetships by increasing the number of funded places available in country and regional areas and expand the cadetships to the metropolitan area.

The minister's response was as follows:

The availability of cadetships in rural areas is reviewed on an annual basis within the Department of Health. The committee's recommendation will be considered in line with the demand for places and capacity for sites to support places. Extension of the program to metropolitan areas is not considered appropriate at this time as the vacancies for enrolled nurses continues to be small in metropolitan areas, and the programs for enrolled nurse education are already oversubscribed.

Admittedly, this response was given in 2006, and perhaps the situation was not as dire in 2006 as it is today. However, it alarms me that, in a time of workforce crisis and at a time when we are clearly filling the gap in acute services in our acute institutions by less than adequately qualified people, we have a recommendation that has obviously been ignored, in particular, for cadetships for enrolled nurses.

I take the view—and it may be completely naive—that, if someone is willing to enter the health profession industry—is trained to do so, particularly in the field of nursing, and they are attracted to the profession when they are a year 12 student at the Wallaroo High School and they can get a cadetship up at Port Pirie to become an enrolled nurse and they have shown interest, having done some work experience at the local hospital while they are at school—and gains a qualification as an enrolled nurse and works up at the Port Pirie hospital, that is a great coup for the nursing workforce.

Furthermore—and, again, I might be naive—my understanding is that you would at least then have a chance to show them that this is a profession that is personally rewarding, if not financially rewarding, and that they would belong to a profession that is a very important part of the health community. It would give them a taste of the profession, which would encourage them to go on to undertake the extra qualification to become a registered nurse. I would have thought that at least you had them in there, but, no, the government's view is, 'We don't have enough spaces and we're not going be opening any more.' I find this completely inconsistent with not only the demand but also the recommendation (after a full inquiry) that there is this one chance to open up this opportunity.

People much wiser than me in relation to health matters, with their professional training and expectations, have undertaken these reviews, listened to all the evidence and had all the players before them, and they have put recommendations as to how this might assist the situation, and then the recommendations go unanswered, when there is some way of resolving this. There is an opportunity with these young men and women—and some more mature-aged men and women who are wanting to retrain to get back into the workforce—to some degree, instead of letting them zip off into aged care or some other service, to make sure that, where we have a shortage, we give them an opportunity to come through and start at that level and develop.

I was most concerned about this at the time. It was an educational issue that I was covering at the time. I wrote to the chairman (the member for Fisher) about this because I was concerned that first, the Nurses Board—whose future powers we have under consideration today—did not have the power to even deal with these matters. This was outside their role and function and that is a concern in itself. I ask that this issue also be brought to the attention of the government, so that it might help to get more numbers on to the registration than it has in the past. I will move on to the extra transparency and accountability issues, if you grant me leave to continue my remarks.

Leave granted; debate adjourned.

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