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House of Assembly - Fifty-Fifth Parliament, First Session (55-1)
2025-09-03 Daily Xml
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Bills

Nurse and Midwife to Patient Ratios Bill

Introduction and First Reading

The Hon. C.J. PICTON (Kaurna—Minister for Health and Wellbeing) (15:54): Obtained leave and introduced a bill for an act to establish nurse and midwife to patient ratios and other staffing requirements in incorporated hospitals, and for other purposes. Read a first time.

Second Reading

The Hon. C.J. PICTON (Kaurna—Minister for Health and Wellbeing) (15:54): I move:

That this bill be now read a second time.

This is an incredibly important piece of legislation and is a landmark moment for nursing and midwifery here in South Australia. The Nurse and Midwife to Patient Ratios Bill 2025 will, for the first time in South Australia, enshrine nurse and midwife to patient ratios in legislation.

The legislation confirms the government's continued commitment to ensuring the safety of our nursing and midwifery workforce within the public health system. It further supports the safety of the public health system and optimises health outcomes for patients. Transparent mandated minimum staffing has been recognised both nationally and internationally as a crucial factor in delivering high-quality hospital care and ensuring best patient outcomes.

The model outlined in this bill is based on the successful model implemented in Victoria, tailored to the South Australian context. It also aligns with the global push towards establishing transparent and consistent staffing standards, including mandated nurse and midwife to patient ratios. This not only supports the delivery of high-quality care, but also helps to ensure that the South Australian health care system is resilient, sustainable and able to meet both current and future demands.

This bill seeks to establish minimum nurse and midwife to patient ratios per shift across key clinical areas, including: general medical and surgical; coronary care; high dependency; oncology; stroke; rehabilitation; birthing and labour; neonatal intensive care; and palliative care wards. The bill will apply to all South Australian public hospitals, including aged care, where it will mirror the federal government requirements of care minutes for all aged-care beds.

The bill will include a two-year moratorium in which a hospital cannot be the subject of a finding that it has failed to meet a prescribed ratio. This will enable SA Health to embed the new staffing approach and to support the implementation as efficiently as possible. The bill also applies the principle of rounding up where the number of occupied beds is not divisible by the prescribed ratio. It will allow operational flexibilities informed by clinical decisions to optimise the efficient use of nursing and midwifery resources.

Our nursing workforce will be able to rely on the higher minimum staffing requirements that apply under the Nursing/Midwifery (South Australian Public Sector) Enterprise Agreement as these will be preserved under the bill. Nurses and midwives are the cornerstone of South Australia's public health system. They provide a vital role in promoting health, preventing illness and delivering care across both acute and chronic primary care settings. Collectively, nurses and midwives comprise nearly 50 per cent of the state's health care workforce, underscoring their essential contribution to the health and wellbeing of the South Australian community. This bill will ensure that the appropriate minimum number of nurses and midwives are available on a shift-by-shift basis, enabling staff to meet patient care needs in a working environment that supports our dedicated nurses and midwives.

We have worked very closely with the Australian Nursing and Midwifery Federation South Australian branch to deliver this bill and I want to take the opportunity to thank them for their collaboration and support in finalising this work. In particular, I want to extend my thanks to the leadership of the. ANMF SA: Adjunct Associate Professor Elizabeth Debars, who is the CEO Secretary; Adjunct Associate Professor Jackie Wood, Director of Nursing and Midwifery practice; Ms Roslyn Hewlett; and Mr Rob Bonner, an Emeritus Director of the ANMF, all of whom have had tireless advocacy into achieving this result of the introduction of this legislation today. We will continue to work in partnership with the ANMF SA and our local health networks to ensure the sustainable implementation of this bill if passed.

I want to extend my gratitude as well to the departmental officers behind the scenes, in particular Judith Formston, Deputy Chief Executive, Department for Health and Wellbeing, and Gabrielle Starr, Director of Strategic Industrial Relations and her team in leading this work on this initiative, as well as to the office of the chief nursing and midwifery team, including Jenny Hurley and the broader team for their work on this bill as well.

I also want to thank—in the chamber today we have Kath Thomas, who led the work in relation to drafting this legislation and Kath is actually retiring after 25 years of public service to this state and this was her final project. So thank you, Kath. She is also joined here by her granddaughter Sophie, who is about to start work next year as a graduate nurse at Flinders Medical Centre, so it is particularly fantastic to have you here as well. I also want to thank Georgia Phillips from my office who has been busily working on this for the past few years.

This bill is a positive change that delivers a key election commitment by the Malinauskas Labor government to enshrine nurse and midwife to patient ratios into law. It reiterates our commitment to supporting the safety of our patients in the public health system and it delivers on our promise to ensure the safety of our valued nurses and midwives. I commend this bill to the house and seek leave to have the explanation of clauses inserted in Hansard without my reading it.

Leave granted.

Explanation of Clauses

Part 1—Preliminary

1—Short title

2—Commencement

These clauses are formal.

3—Interpretation

Definitions are provided for key terms used throughout the measure.

4—Objects of Act

This clause sets out the objects of the proposed Act.

5—Act not to affect employment contracts

This clause provides that nothing in the proposed Act is intended to affect or require the alteration of any employment contract.

6—Application of Fair Work Act 1994

Following the commencement of the Act, SAET may not approve an enterprise agreement which would provide for a minimum staffing level applying in a ward or other hospital site to which a ratio or minimum staffing requirement applies pursuant to the proposed Act.

Part 2—Staffing requirements in incorporated hospitals

Division 1—Nurse and midwife to patient ratios

7—Application of ratios

This clause imposes the obligation on an incorporated hospital to staff a ward in accordance with an applicable ratio (set out in the Schedule). It also provides further guidance as to how ratios are to be applied, including imposing an obligation for an additional nurse or midwife where the application of a ratio to the number of patients on the ward does not result in a whole number of nurses or midwives.

8—Ratio for mixed wards

A process is set out for the staffing of wards to which more than one ratio would otherwise apply. An incorporated hospital must nominate such a ward as a mixed ward and staff the ward in accordance with the provisions of this clause.

9—No breach in circumstances of emergency

This clause provides that an incorporated hospital will not be in breach of a ratio if the failure to meet a ratio arose from an unanticipated emergency situation, and the hospital determined the actual staffing level to be safe.

Division 2—Variations from ratios

10—Quality of care paramount

11—Agreement to vary a ratio

These clauses provide a process by which a ratio applying to a specific ward can be varied by agreement between the Chief Executive and a union. A ratio as varied would then apply to the relevant ward instead of any ratio applying under this measure.

Division 3—Other staffing requirements

12—Minimum staffing requirements

This clause imposes the obligation on an incorporated hospital to staff a hospital site, ward or bed in accordance with an applicable minimum staffing requirement (set out in the Schedule).

Division 4—Effect of existing enterprise agreement

13—Relevant enterprise agreement of no effect

The enterprise agreement applying to nurses and midwives at the time the Act commences is to have no ongoing effect to the extent it provides a requirement for minimum staffing in the same setting as a ratio or minimum staffing requirement imposed by this measure. Proceedings which relate to disputes as to minimum staffing levels contained in the enterprise agreement will not be able to be brought.

14—Preservation of existing higher staffing level requirements

Despite the preceding clause, a minimum staffing level imposed by the enterprise agreement which requires more nurses or midwives than would be required through the application of the Act will be preserved. These requirements will be treated as if they are a ratio or minimum staffing requirement imposed by the Act.

Part 3—Dispute resolution

15—Local dispute resolution

A dispute arising under the Act is to be initiated through notification to the relevant incorporated hospital and resolved in accordance with prescribed procedures and policies. Such a dispute may be initiated by a nurse or midwife employed to work at the relevant hospital, or by the union.

16—Dispute resolution by South Australian Employment Tribunal

If the parties to a dispute initiated under clause 15 are unable to resolve the dispute in accordance with that clause, they may apply to SAET (constituted as an industrial relations commission) to resolve the matter. The clause also sets out the procedures and powers of SAET in dealing with such a dispute.

Part 4—Civil penalties

17—Civil penalty for breach of ratio or other staffing requirement

A nurse, midwife or union may also apply to SAET (constituted as the South Australian Employment Court) to have a civil penalty ordered against the incorporated hospital for a breach of their obligation to comply with a relevant ratio or minimum staffing requirement. A civil penalty may only be ordered where the contravention was deliberate and part of a systemic pattern of conduct by the hospital. Any penalty ordered is payable into the Consolidated Account.

18—Civil penalty rules and procedure

This clause provides that a civil penalty is not a criminal offence and that the Court in hearing an application for such a penalty must apply the rules of evidence and civil procedure.

19—Costs

The Court may only award costs against a party to proceedings under this Part if of the opinion that the party has acted unreasonably, frivolously or vexatiously.

Part 5—Miscellaneous

20—Certain information to be included in annual report

Information relating to dispute resolution and civil penalties must be included in each incorporated hospital's annual report.

21—Regulations

This clause provides a regulation making power. Regulations made under the Act may amend hospital category sites, and add new wards to which a ratio is to apply.

Schedule 1—Staffing requirements at incorporated hospitals

Part 1—Categories of incorporated hospital sites

1—Category 1 hospital sites

2—Category 2 hospital sites

3—Category 3 hospital sites

4—Category 4 hospital sites

These clauses categorise certain hospital sites across the State. Some ratios require a different number of nurses or midwives depending on the category of the hospital site.

Part 2—Nurse and midwife to patient ratios

5—Acute stroke wards

6—Antenatal wards

7—Birthing suites

8—Coronary care units

9—General medical and surgical wards

10—Geriatric evaluation and management units

11—Haematology wards

12—High dependency units

13—Neonatal intensive care units

14—Oncology wards

15—Palliative care inpatient units

16—Postnatal wards

17—Rehabilitation inpatient units

18—Special care nurseries

These clauses provide ratios requiring a certain number of nurses or midwives per patient on certain wards of incorporated hospitals.

Part 3—Minimum staffing requirements

19—Small hospitals

This clause provides a minimum level of staffing for a hospital site that is not a Category 1, 2, 3 or 4 hospital site.

20—State aged care

This clause provides a minimum level of staffing for aged care beds in State hospitals.

Schedule 2—Related amendments and transitional provisions

Part 1—Related amendment to Fair Work Act 1994

1—Amendment of section 79—Approval of enterprise agreement

This amendment to the Fair Work Act 1994 is consequential on proposed clause 6 of this measure.

Part 2—Transitional provision

2—Moratorium on applications to SAET

Disputes arising under the Act may not be resolved through SAET and proceedings for civil penalties may not be initiated for a period of 2 years after the Act is assented to. During this time, staffing requirements imposed by the existing enterprise agreement will be enforceable, despite the operation of proposed section 13.

Debate adjourned on motion of Mr Teague.

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