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House of Assembly - Fifty-Fifth Parliament, First Session (55-1)
2025-09-16 Daily Xml
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Bills

Nurse and Midwife to Patient Ratios Bill

Second Reading

Adjourned debate on second reading.

(Continued from 3 September 2025.)

Mrs HURN (Schubert) (15:46): I rise to speak to the Nurse and Midwife to Patient Ratios Bill 2025, and indicate that I am the lead speaker for the opposition. It is pretty clear that nurses and midwives really are the backbone of our entire health system, and the work they do to support us in our communities, to support us in our local hospitals as well as our tertiary hospitals, and the way in which they do it with such care and compassion really is incredible, not just in the country but in the city as well.

The ANMF have lobbied really hard for this bill, which enshrines nurse to patient ratios in law, as they exist in Victoria and Queensland with other states also mandating ratios. What is the nurse to patient ratios bill? It has been spoken about quite a bit; in fact, it has been spoken about quite extensively, particularly in the lead-up to the last election in 2022, when the ANMF made a request of both major political parties to commit to this policy. The Nurse and Midwife to Patient Ratios Bill establishes a minimum requirement for the number of nurses or midwives per patient in public hospitals across South Australia and is largely modelled on the Safe Patient Care Act already in place in Victoria.

The minimum requirements are outlined in schedule 1, part 2 of the bill. The bill provides for a two-year phase-in period, after which hospitals could be fined up to $10,000 for failing to meet the ratios required, money which will be paid directly to Treasury. In asking questions at my briefing last week, it was advised that this money is not going to be ring fenced for health spending under Labor's proposal.

There are a number of variables in the ratio requirements, and these are based on the type of patient care being provided as well as the hospital site. The volume and acuity of patients being cared for influence the ratios required by the bill. There are four hospital categories in the bill, and they have really been mapped against the Victorian hospital sites. It looks at a whole host of different data, whether that be ED presentations, inpatient days by quarter, and verification of staffed acute inpatient beds.

We first of all had the category 1 sites, the major tertiary hospitals, which are obviously Flinders, the Lyell McEwin Hospital, the Royal Adelaide Hospital and the Women's and Children's Hospital. The category 2 sites are the Modbury Hospital, Noarlunga Hospital and The Queen Elizabeth Hospital, and category 3 sites include the Riverland General Hospital, Mount Gambier and Districts Health Service, Whyalla Hospital, Port Lincoln Health Service, Gawler Health Service, Mount Barker hospital, Murray Bridge hospital, Port Augusta Hospital, Port Pirie hospital, Port Pirie Regional Health Service, and the Southern Fleurieu Health Service. Category 4 hospitals include the Naracoorte Health Service and Wallaroo Hospital and Health Services. There are separate requirements for smaller hospitals; that is, any hospital that I have not yet listed above.

The ratio required varies according to the categorisation of the hospital, the 14 types of care detailed in the bill and the shift. For example, in antenatal wards the ratio required is one midwife for every four patients and one midwife or nurse in charge during the morning and afternoon shifts. On the night shift the requirement is one midwife for every six patients.

Acute stroke wards require one nurse for every three patients and a nurse in charge, whereas geriatric evaluation and management units require one nurse for every five patients and one nurse in charge on morning shift. For the afternoon shift they require one nurse for every six patients and one nurse in charge, and for the night shift they require one nurse for every 10 patients and one nurse in charge. General medical and surgical ward ratios depend largely on the category of the hospital and the hospital site. The bill requires that small hospitals not listed in one of the four categories have at least one registered nurse and one other nurse or midwife on all of the shifts.

As I have mentioned, this is largely based on the Victorian legislation. The Victorian legislation does include the ratios for emergency departments for operating theatres and the like, but this bill proposed by the government does not currently include those EDs and ICUs and things like that. This is an issue which I have raised and spoken about at length with Elizabeth Dabars from the ANMF. These all have been determined based on really lengthy consultation with the ANMF and, as I stated, they have indicated to me their support for all the ratios required.

I was really grateful for the briefing that I received from SA Health and the minister's team last week. Thank you for making yourselves available. I have also had several lengthy conversations with Elizabeth Dabars from the ANMF.

I indicate that the opposition will support the passage of this bill and that it supports the intent of the bill, but there are some further points that I would like to put on the record. Ratios alone are not enough, because simply legislating ratios does not create nurses and does not create midwives. Ratios alone are not enough. The big challenge is whether the government can actually deliver the workforce that is required to meet these targets and to meet these ratios, and that is particularly true for regional communities.

Workforce shortages, it goes without saying, are a huge concern across regional South Australia right now. I do not think there is a member in this place who has not raised workforce issues on behalf of their local community. I do not believe there is a country member who has not written to the health minister to bring to his attention the concerns of local communities as they relate to the health workforce, particularly nurses and particularly GPs. Some genuine concern has been raised about the impact that the ratio requirements will have on regional hospitals, particularly noting these challenges.

Reflecting on my own local community, for instance, the Angaston emergency department has been closed on multiple occasions, and locals need to drive to Tanunda, go to Gawler and go to the Lyell McEwin Hospital for their emergency care. The Tanunda hospital, in particular, has had a reduction in its bed numbers, based on the fact that they cannot recruit an additional nurse. I think if we have a challenge recruiting nurses to the beautiful Barossa Valley, which is quite literally only an hour away from the CBD, what does that mean for other regional communities, whether that is the member for Narungga's community, the member for Flinders' community, the member for Frome's community, and so on and so forth?

We hear so many similar stories from right across regional communities, and that is why I say that ratios alone are not enough. We must have incentives on the table, and this must form part of a much broader workforce strategy when it comes to nurses and midwives in South Australia.

I asked specifically, during my briefing provided by SA Health, whether the bill would lead to hospital beds being closed as a result of an inability to find the required staff, particularly in regional communities. Of course I appreciate and understand, and I was told, that this is not the intent of the bill—of course it is not—and I was told that there was confidence that agency staff could fill these gaps.

I want to be really clear that in supporting these ratios—which we put on the record today that we do—we will not tolerate any closure of beds or any closure of wards. The bill demands additional action from this government to attract nurses to regional communities and retain them, and that is exactly what we expect. Through the committee stage, which I indicate we will be entering at some point throughout the debate, we will be seeking categorical assurance from the minister that hospital beds will not be closed as a consequence of the staff-to-patient ratios not being met.

This is also a point which I had a conversation with the ANMF about. They were really forthright in saying again that this is not the intent of the bill, and they will do everything within their power to ensure that hospital beds and wards in regional communities particularly are not closed because of a failure to get the requisite nurses and midwives to staff these wards. We do not want that to be a consequence of this bill, and that is why we say ratios on their own are not the sole answer: they need to form part of a much broader suite of policies to attract nurses to regional communities and retain them.

The bill allows for a two-year moratorium before breaches can be taken to the tribunal. That means that there is a two-year window to build the workforce that we need to build these ratios and have a strong pipeline of nurses. It is not about just meeting the demands of the health system now, it is about what is required when we are looking at all these population projections. In my community alone—and, Deputy Speaker, you are on the boundary of this—at Concordia 25,000 people are moving in, and at Roseworthy, in the member for Frome's electorate, 80,000 people are scheduled to move in there over the course of the next decade and a bit, and that is just in our little patch in the north.

When we look at the growth right across regional South Australia, and indeed the entire state, it demands more action when it comes to workforce. We are falling short as it is. In fact, I heard the minister in his press conference say that, if this bill were rolled out now, we would be short of around 100 nurses. So that's where we are at the moment. The government is confident that they can meet these ratios over the next two-year period, and that is fantastic, but we need to do more to actually meet the demands of the future—the next 10 years, the next generation, the next 50 years and so on.

The two-year window: it is interesting, and I have already mentioned this, but in the briefing it was uncovered that, yes, $10,000 is the fine if you are deliberately and systematically failing to meet these ratios. I note that there has not yet been a single breach in Victoria, as far as I can see, in terms of money being paid to the government, noting that that is paid from the LHN to Treasury, so it is kind of passing the money around between government organisations. I do think it is interesting, though, that the money and the fines—the $10,000—are not ring fenced for the purpose of health, or are not ring fenced for there to be a campaign or a strategy to actually attract nurses to regional communities. By the nature of a government actually being fined for failure to meet the ratios, that in itself speaks to a need for the government to invest more in attracting and retaining nurses.

So this is something that we are really keen on the government doing. I raised this with SA Health, and my understanding is we will be having those conversations with Treasury. I think it is a commonsense move. I understand that the money needs to be paid through Treasury, but surely they can actually ring fence it for the purpose of health. I can see one member nodding, saying that is a commonsense suggestion, so thank you very much.

The bill is, as I say, just one piece of the puzzle. The government really does need to act now to deliver a few more things. They need to develop a comprehensive health workforce plan, offer better relocation incentives for nurses and midwives who are willing to actually take up posts in regional communities, and invest in retaining nurses and midwives who are experienced because their mentorship is really critical. These are obviously key points that the opposition is focused on as we are heading into the next state election, and we will have our workforce policies that we will be announcing in due course.

So the opposition does support this bill. We support safe staffing levels for the city and for country patients alike. As has been spoken about in this house, it is not just about making sure that patients who are coming to our hospitals get the care that they need; it is also about creating a safe environment for nurses who work around the clock. I know that there are members in this place who have worked in that profession, and no doubt there are nurses who are tuning in and listening to the contributions of all of us here in this house. It is important to put on the record that we value the work that they do. Our health system would not function without them. Supporting this bill is the least that this parliament can do, I think, to provide some care.

That is not to say that we will not hold the government to account for ensuring that there are enough nurses and midwives to fill all the rosters. We will hold the government to account for keeping emergency departments open and staffed. We will hold the government to account for making sure that South Australians see real improvements in their health care. I am sure that all country members, particularly, in the parliament will speak to this, but every South Australian—no matter what their postcode, no matter which part of South Australia they live in—deserves to have access to quality health care. They deserve to have emergency departments that are open. They deserve the health care that we see in the city, quite frankly.

This bill does set the minimum standard, and now the real work begins to ensure that we have the nurses and midwives who can actually deliver this and make a real, meaningful impact for the health system in South Australia. We will continue to ask questions until the government delivers for patients right across the state, especially for our regional communities.

I am looking forward to the commitment, the promise, from the minister that no regional bed and no regional ward will be closed as a result of this. I appreciate it is not the intent of the bill, but we do need to see some pretty strong statements that this will not happen and that there will be enough agency staff to actually fill the rosters, because we do not want that to be an unnecessary by-product. We support the bill and are happy to do so. I commend the bill to the house.

The Hon. N.F. COOK (Hurtle Vale—Minister for Human Services, Minister for Seniors and Ageing Well) (16:01): As a nurse since leaving school, working for three decades across so many different clinical and management roles, I am really delighted to speak in support of the South Australian Nurse and Midwife to Patient Ratios Bill 2025. I have been a long-time supporter of this legislation and I was really delighted to see the commitment to this as part of the Malinauskas then-opposition's commitments at the 2022 election, because legislated nurse and midwife to patient ratios are not just ethically right: they are evidence based, cost-effective and absolutely essential for quality, safe care in our health system.

This important legislation has been a key commitment of our first term of government because it is such an important part of improving care quality in our public health system. The ratios will become legally enforceable minimum standards that set how many patients a nurse or midwife can actually provide care for or be responsible for per shift, depending on the time of day, the ward type and the acuity. They ensure workloads are safe, predictable and consistent.

The policy began to be implemented in Queensland during 2016, then introducing a minimum nurse to patient ratio in acute medical and surgical wards. I did a bit of research and there are some rigorous evaluations—in fact, it was quite the rabbit hole and kept me reading for some time. Some were published in The Lancet in 2021 and showed that the policy has indeed saved lives, reduced hospital readmissions, shortened lengths of stay and even, in turn, reduced costs.

So the research speaks to the policy delivering significantly improved patient outcomes while being cost-effective. The cost savings from these improved outcomes most certainly exceeded the increased costs of hiring additional nurses, making it a beneficial public safety measure and a viable policy for other jurisdictions to consider. We really do not need research—although it does exist—to show that higher nurse staffing or midwife staffing, i.e. fewer patients being taken care of per healthcare worker, is associated with lower mortality and fewer adverse events. Adverse events are things like hospital-acquired infections, complications and falls. It leads to shorter hospital stays and lower readmission rates.

For maternity services, there is evidence that better midwifery staffing in postnatal wards improves outcomes for mums and babies, reduces the time in special care nurseries and reduces patient incidents. This also in turn, for an area of health care that is so passionate and so determined to engage in the family's wellbeing, provides a much better staff experience.

In summary, there are most certainly benefits beyond patient health. We can look at workforce wellbeing and retention. When nurses and midwives are overburdened, overworked, suffer from injuries, emotional fatigue, burnout and high staff turnover, we can see that legislated staffing ratios will help to reduce workload stress, increase job satisfaction and reduce attrition. We can look at predictability in the staffing model, fairness and transparency of that staffing commitment for each shift.

If we legislate for ratios, hospitals have to plan and budget accordingly. We can use a whole range of tools to do this, but if we have legislated ratios, this is transparent and it can be seen in advance. Shift leaders have a much clearer view and expectation of what the next shift will look like and staff are protected. This also reduces unfair workloads, arbitrary unfair workloads. Especially if you have an experience of surge during the shift, you know that there is this minimum level of staffing that you have to fall back on.

I talked earlier about cost savings. Although more staffing does cost up-front in recruitment, training and employment, we know, as I described before, that the evidence shows us there are fewer adverse events. These cost money. An extra day in hospital for a patient costs thousands of dollars and needless to say as well a bed that is blocked up with someone, and it could have been preventable. Over time, this will help us to create a much more efficient and safer system.

Why is this not just policy? Why are these not just guidelines? Why are we enshrining it in legislation? Sadly, I am old enough to be able to say we have been doing that for decades. We have had policies, we have had guidelines, we have had little numbers in brackets in boxes next to the wards that you are staffing that are a guideline for the minimum number of staff per bed. We know when sometimes a hospital is quiet and there are some beds that are not being used, you can take a staff member from that unit and put them in another.

We know these guidelines have existed for a long time. But nurse and midwife to patient ratios that have been a tool in staffing since well before I started nursing have been just that, just a tool, not legislated. Voluntary targets or guidelines often fail to be met in practice, especially in times of pressure during busy shifts and shortages of staff. With legally binding standards, we see accountability at another level. Legislation sends that signal.

We as a government, and I am sure those opposite, value safe staffing and we are prepared to be held to account. It ensures consistent minimums across our hospitals, across the wards, and not just the best-resourced ones. I see huge benefits for South Australia with the development of this commitment via legislation. I can see better performance and I can see safer patient outcomes and workforce sustainability by becoming a much more attractive system to work in. In turn, this will assist our recruitment targets and our retention.

Over the past three years, since March 2022, the South Australian government has recruited an additional more than 1,462 full-time equivalent nurses and midwives above attrition for public hospitals on top of the doctors, allied health professionals and paramedics. We have so many hundreds of additional staff across the system. This is an achievement that we are really proud of. During that same period, I know we also committed to 600 extra hospital beds, so these additional nurses are vital when those beds are all opened up. I know we are a long way towards that.

In 2024, South Australia undertook its biggest ever graduate nurse and midwife intake, via the Transition to Professional Practice Program. Over 300 graduates were taken on at the Royal Adelaide and The Queen Elizabeth hospitals alone. That is an extraordinary achievement. These additional staff will be essential when we deliver the mandated ratios in our public health system. In large metropolitan hospitals such as the Royal Adelaide, the Lyell McEwin and Flinders, as well as the Women's and Children's, there will be approximately one nurse mandated for every four patients. That is in general medical and surgical wards in morning and afternoon shifts, and then at night that changes as well.

I heard the member for Schubert talk about some of the ratios that are enshrined within the legislation, and I have had a look at the very complicated table and rubric that will be used as the legislative guide. It certainly is an improvement on the ratios or the guidelines that we have seen before. What I also heard was some question around some of the specialty units. What you can see in the rubric itself is that different areas have different staffing ratios, and that is because the acuity, the complexity and the needs of the people within those different cohorts—thinking about rehabilitation nursing, neurological nursing, a whole range of different cohorts of patients—does require different modalities of health care to be delivered. That is why we see a range of different ratios in a range of different places.

I just want to quickly talk to critical care and the emergency department. Like other specialist units—high dependency and what have you—there are different minimum staffing levels being set out in this legislation. As a critical care nurse, I can assure people that there are already set ratios, as attested to by professional organisations such as the Australian critical care nurses association. Underneath those ratios, there is a range of treatments and care modalities such as ventilation, ECMO, haemodialysis and a range of others where you need to have additional staff. Within those guidelines as well, there is also a whole range of set standards around qualification of staff.

So it is not just a simple statement, 'We will have one registered nurse to one patient in the intensive care unit,' but there is also a ratio of people with qualification to patients within the unit. So while I absolutely appreciate the statement and the question around intensive care and emergency departments, there are also already very strict levels that nurses can point to when they are running a shift to say, 'No, hang on a minute. We have 25 patients, 15 are ventilated, five have external breathing support, another three are on ECMO, and we have 10 dialysis patients. We need this, this, this and this.' It is a bit more scientific within those specialty units.

Having done that staffing for a number of years, I can tell you that the nurses are pretty solid. The nurses are good advocates and they are pretty solid when it comes to those things. The emergency staff know when there are surges and things happening as well, so emergency departments also have a minimum number of staff. Just because there are zero patients in the emergency department, you cannot leave them with zero nurses. You have to staff it as if the beds were full. It is difficult, but that is how it happens.

Other smaller metro hospitals will be similar, but there are variations from one site to another, and then we talked to regional hospitals. Of course, with regional hospitals, when you are attending a hospital in your town, you absolutely should be getting the best possible attention. I know there are some different ratios being set, depending on the type of hospital, but it will be stricter than ever before. I look forward to listening through the committee stage and also watching in the future how this rolls out.

We do know it is harder to staff regional and rural areas. The legislation does include provisions, which I think does ensure more equitable statements around hospitals so that rural hospitals are not disadvantaged, and I look forward to that. South Australians rightly expect timely and respectful care. When people present to hospital, again rightly, they expect sufficient skilled nurses or midwives to monitor, to care for and to respond to them and also to their loved ones who attend with them. Overwork, burnout and insufficient staffing all compromise care and erode the trust that the public has in our health system.

This legislation futureproofs. It ensures our nurses and midwives, in turn protecting the health of the public and enhancing wellbeing. As a parliament, we are ensuring patients receive safe care and that our nurses and midwives perform their roles with dignity. I know I would have welcomed this when I was doing the role of after-hours nurse coordinator in our public hospitals. I know my friends and colleagues who are still doing that important work across the system are very excited to see these ratios are coming, and they will absolutely appreciate that we have got bipartisan support to deliver this important work.

I take a moment to congratulate my friend, the Minister for Health and Wellbeing, Chris Picton, on this incredible work. I also thank and acknowledge all the people who have assisted from SA Health, as well as Elizabeth Dabars and my friends at the ANMF and, importantly, my nursing and midwifery friends and colleagues—we are nothing without you. I commend the bill.

Ms PRATT (Frome) (16:17): I rise to speak today on the Nurse and Midwife to Patient Ratios Bill 2025 and, along with our lead spokesperson, the member for Schubert, signal my support and the opposition's support for this bill, with the disclaimer that there remain questions that the opposition intends to pursue through the committee stage.

At the outset I want to acknowledge the extraordinary work that we see from our nurses and midwives throughout South Australia, but I get to speak most passionately about the nurses and midwives that I see and know working in regional South Australia and even closer to home through my electorate of Frome. They certainly are the frontline of our local regional health networks and they do their work with enthusiasm, limited resources sometimes and compassion, but also vulnerability.

We have heard this year through different parliamentary committees what that vulnerability looks like. It is a threat to their safety and it is often without the resources they need, particularly on night shift, to do their work. It is not without strong advocacy from the ANMF, but nurses on their shift at small country hospitals are caring for people they live alongside, and they do extraordinary work. As country MPs, we know that they are also the people you bump into at the local shop, they play netball, they volunteer, they are active in the community and they are busy at local schools. We must not take for granted the role that they play in caring for our elderly relatives and the people we love, young and old.

I give a special shout-out to the Director of Nursing at Clare Hospital, Jodie Kernick, who is one of those leaders through the regional health system who does an extraordinary job at an elite professional level to coordinate all the machinations and goings-on of a very busy Clare Hospital. I will come to that hospital later, because it is not formally listed within the ratio allocation, but it matters. It is an important hub hospital in a big catchment area through the Clare Valley. We are a long way from Port Pirie, we are a long way from Gawler, yet the services that are provided at Clare Hospital by our nurses and midwives are without peer.

I take this opportunity to pay a very special mention to a lovely lady called Helen Mary Ashby (nee Wray), who passed away last week. She was a nurse, aged 85, who never stopped, with a twinkle in her eye, looking after her community, volunteering to health services through Red Cross and the RFDS and any other way that she could. Even through her own health battles, she took her knowledge of the health system and challenged her oncologists, her doctors, the nurses in the local community, coordinating her own treatment that was required because she could not receive it in Clare and had to drive herself elsewhere. Here was a nurse who understood the system, here was a nurse who understood the limitations of the system, but also someone, in her later years, who set the bar high for the modern-day nurses and doctors in our region. My love and affection goes out to her children, Jo, Susie and Nick, who have lost a ripper in Helen. Vale.

This bill seeks to enshrine nurse and midwife to patient ratios into law, strongly supported by the ANMF. I cannot speak highly enough of the advocacy that they bring and have brought to a very long, across many years, negotiation of this bill. Again, the opposition supports its introduction. We support and value their feedback, their availability in meeting with us to speak to the bill and to provide their version of a briefing and also their guidance on how this bill will actually support our nurses and midwives. I want to formally thank Elizabeth Dabars, who is a beacon for her industry, her sector and her nurses and midwives.

I also want to thank my colleague the member for Schubert, who in leading this bill for the opposition through the house, not just in her role as shadow minister for health but as a country MP, represents someone closely connected to her own community. She is a fierce advocate for her own health network, the workforce and the infrastructure. Therefore, she is a leader not just for the opposition but in the public space when we need to test the government's priorities when it comes to investing in health. I thank the member for Schubert for her role today.

We have many reflections to make on this bill. I will take this time to move through my own observations of what it is about this bill that may give pause for thought or require some level of testing through the committee stage. Firstly, on the themes or the position of cost and sustainability and workforce shortages, the opposition does not shy away from the challenge we are setting for the government about missed opportunities and gaps still in the market to deliver on workforce planning, to close the gaps and prevent those shortages.

Country health is a house of cards when it comes to the fragility of workforce shortages. We see that front and centre when it comes to the availability of midwives and the critical, essential role that they play in comforting and guiding women, expectant mothers, maternity patients, through that journey. It should always be an option for women in the country to deliver their baby as close to home as possible. We have seen that compromised a number of times from the Riverland to the South-East, Kangaroo Island, Whyalla for 12 months and Kapunda on diversion to Gawler. So today is about our nurses, and we see those services delivered when those nurses and midwives are available.

We know the intent of this bill is to strengthen the supply of nurses to our country hospitals, but this bill does need to be tested on some of the vulnerabilities around that, because, as the member for Schubert said, ratios alone are not enough. We need to see the legislative infrastructure wrap around that ratio, as well as government commitments through policy settings and funding.

There is a risk of some operational rigidity where our hospitals, which are already under enormous pressure, might lose some flexibility to manage those patient surges, especially through the flu season or emergencies, whether that is a natural disaster or a road fatality—we cannot always know what those emergencies are. But they need to have the capacity to flex up or down, because rigidity and a lack of flexibility is never a good thing. So the rounding up of ratios might mean unnecessary overheads that therefore divert resources away from patient care, which we would not want to see.

The regional and small hospital impact requires all the attention that I can give it as the shadow minister for regional health services and a country MP. It is my deepest concern, particularly where we see the bill outline how it will apply ratios from the biggest, to regional and medium-sized hospitals, but not one of them is listed in my electorate and I have many, from Jamestown to Burra to Clare to Balaklava, Kapunda and Eudunda. It is important that they are captured in my reflections and comments to make sure that the government takes note of nurses who work in those hospitals who have not been given due recognition.

It is right and fair to say that all across South Australia in our health network, where there have been not just workforce shortages but a lack of housing, the pressure on directors of nursing, like Ms Kernick, has been an inability to recruit nurses—regardless of a ratio—where the budget allows for it, because that housing has not been available and our communities have missed out, and Clare is no orphan in that scenario.

When it comes to ratios, this is not the first time we have seen them applied. We just need to look to the aged-care sector where, under the federal Labor government in the previous term, as a result of the royal commission, we saw mandates being applied to the health workforce that registered nurses would always be available to an aged-care facility 24/7. But if the workforce does not exist, if that person is not available, then the mandate becomes a sword of Damocles moment where a facility is having to meet a legislative mandatory requirement and cannot.

Questions need to be asked about the penalties, because we have seen to devastating effect in the aged-care sector, particularly interstate but there were some South Australian examples—if you cannot meet the legislative requirement, if you cannot meet the mandate and there are penalties that have been legislated for that—facilities closing and relocating elderly people many kilometres away from what was familiar. We know and understand the intent of the bill, but we have to look for unintentional consequences and make sure that they have been captured or reformed.

We will be asking questions and reflecting on how the bill, the legislation, and hospitals, employers, will realistically comply with ratios that are designed for large metropolitan hospitals. That may become apparent through the committee stage but, for the smaller country hospitals that have not got a voice through this process, we do not want them burdened by ratios they cannot possibly ever comply with. If they cannot meet those ratios, are we going to see hospitals or beds closed and a downturn in services? We know that is a slippery slope.

I argue again that midwives are the canaries in the mine: if we cannot stabilise the workforce, if we cannot recruit, retain, employ and support our midwives and our nurses we quickly lose the other services in our hospitals. I bring that back to maternity patients: if a midwife is not available, we have seen time and again a country hospital diverting that service elsewhere, and when we lose that service completely that hospital is under threat to be closed, when we lose the team that wraps around that patient, whether it is an anaesthetist, a surgeon, or GPs with particular specialised skills. It is a slippery slope, and it is important to ask questions for all the imagined consequences so that we do not end up there.

We certainly do not want to see patients being forced to travel further away from family and community to receive that care by virtue of a local hospital being closed—and we have seen emergency departments, through COVID and post COVID with a reduced GP workforce, that EDs are closed. Only a few weeks ago the Kapunda ED was set to be closed for an entire weekend if not for the fact that the local GP put up his hand and said he would cover those shifts. It is heroic work, but it is unsustainable.

In further reflections on timing and possible enforcement, we note that the bill contains a two-year moratorium before those penalties apply, but I think we need to be asking questions about what happens in the meantime. To return to this common refrain about workforce shortages, legislating these ratios does not magically create more nurses. A lot more work needs to be done and the Liberal Party, the opposition, has very much believed in the importance of incentives in the health system, in health services. We know we are competing against other opportunities being offered interstate, and we are facing a serious workforce shortage without that plan to incentivise to recruit and retain.

Retention is an important part, because while there are a lot of positive signs about recruitment and graduating nurses and employing them, it is also understood in the nursing sector that where short term incentives are available that can be a very attractive contract in the short term. However, the retention of our new nurses is so important, because we want them to stay, we want them to stick with their nursing fraternities, stick to the location they have moved to—hopefully they are enjoying it. We need to pay more attention to retention.

That is especially so in the regions, particularly where we are seeing an explosion of population around the Greater Adelaide Plains, which encompasses at least a third of my electorate—not just in population but in territory. I am absolutely committed to seeing better health services being made available to communities like Balaklava, Malala and Two Wells, which are not considered regional; the schools are not considered regional. Being surrounded by farmland obviously is not enough.

The challenge to attract GPs to those communities to support clinics and therefore to provide better patient care is one of the greatest challenges we continue to face. That is the gap; that is the piece missing from this government when it comes to incentivising a workforce to choose the regions, to choose our state and to choose working in the health profession. It only gets worse from here in terms of population. We know that targets have been set to grow those communities, and the infrastructure and services have to go along with that.

The opposition acknowledges the Australian Nursing and Midwifery Federation's strong advocacy for this bill. I have also heard Elizabeth Dabars make public comment that it is one thing for the government to announce the new beds within its hospital system, but when that patient pushes a bell and no-one comes then you have not delivered patient care. This is very much a bill that centres around the workforce, the human element, the profession and the professional standard that we see our nurses and midwives bring, but the government needs to go further than just delivering a bill around ratios, to improve employment opportunities for our nurses and midwives and a standard of care for our patients.

We will continue to hold the government to account on details such as funding, flexibility and workforce planning, and we need to see them make these reforms work. Above all, we will continue to stand up for country South Australians. In my region, that remains the communities that either have a hospital—through Jamestown, Clare, Burra, Balaklava, Kapunda and Eudunda—or those little communities that do not and have to travel to access that. The concept of losing any of those hospital services, whatever they might offer, is really a threat to the viability of the families that live in my regions. On that note, I commend the bill.

Ms CLANCY (Elder) (16:36): I rise today in support of the Nurse and Midwife to Patient Ratios Bill 2025, which seeks to introduce a new nurse and midwife to patient ratios act and amend the Fair Work Act 1994. The bill before us today seeks to enshrine safe nurse-to-patient and midwife-to-patient ratios in our state's law. This is about ensuring safety for both South Australian patients in their time of need and safety for South Australian nurses and midwives who provide frontline care to our community every single day. We know that safe staffing levels save lives, and we also know that transparent, mandated ratios are critical to delivering high-quality health care and the best outcomes possible for patients.

This bill establishes minimum nurse and midwife staffing levels across a wide range of wards, from general medical and surgical wards to oncology, palliative care, neonatal intensive care, and birthing suites. This will also cover all our major public hospitals, from Flinders and the RAH here in Adelaide to regional hospitals such as Mount Gambier. Crucially, these ratios will apply shift by shift, providing certainty for staff and families. Nurses will no longer be stretched between too many patients or midwives tasked with an impossible workload of postnatal care. Instead, this Malinauskas Labor government is stepping up and stepping in to guarantee minimum safe levels of care.

This important reform will be rolled out over two years, giving SA Health and our local health networks the time they need to smoothly implement these changes. During this moratorium, hospitals will be supported to comply with the new ratios until 2028, when any deliberate or systemic breaches may attract a penalty. It is critical that this reform also recognises the importance of flexibility, allowing for variation in mixed wards; protects the higher minimum staffing requirements for nurses in the enterprise agreements; and protects hospitals if they cannot meet their ratios during genuine emergencies. This reform does not stand alone. This is part of a suite of legislative change and work the Malinauskas Labor government has done and will continue to do to build a bigger, better healthcare system.

In early 2022, before I was elected to this place, a priority 1 emergency ambulance only arrived on time for one in three South Australians—now, it is more than two in three. In the little over three years since we were elected, we have recruited more than 1,460 additional nurses and midwives, and that is part of more than 2,700 extra doctors, nurses, midwives, ambos and allied healthcare workers we have recruited over attrition. We are delivering more than 600 new hospital beds and opening a range of services, such as 24/7 pharmacies, including the very successful 24/7 pharmacy in my community in Clovelly Park, to significantly relieve pressure on our emergency departments.

Just this weekend, I had the pleasure of joining the Premier, our Minister for Health and Wellbeing, Chris Picton, as well as our fabulous candidate for the seat of Colton, Aria Bolkus, as we opened a brand-new, 24-bed rehabilitation service opposite The Queen Elizabeth Hospital. It would be remiss of me not to also mention that the member for Cheltenham was there—sorry, minister; Minister Boyer will love that. This purpose-built facility was designed with the input of both consumers and carers, to ensure it can provide appropriate high-quality health care for mental health patients, taking much-needed pressure off our emergency departments.

I really want to thank Brooke, whom I met with on Sunday, for all of her work as a consumer on the consumer reference group, to ensure this new facility meets the needs and expectations of consumers. The importance of lived experience in the design of these facilities is really, really important and cannot be overstated. The new unit is part of a huge expansion at The QEH, and will soon be joined by two more 24-bed rehabilitation units that are currently under construction at Noarlunga and Modbury.

In closing, I would like to thank the nurses and midwives, and their union—the Australian Nursing and Midwifery Federation (SA Branch)—for their tireless advocacy, to see this reform brought to this place. It has been a long journey for them. I remember meeting with the SA branch of the Australian Nursing and Midwifery Federation on this same issue of nurse and midwife ratios more than five years ago now—I guess six years ago; it seems like a lifetime ago—when I was running for the federal seat of Boothby. I supported them then and I support them now, and I am so happy that we have got them there.

Labor governments are always at their best when they are reforming in the interests of working people, and we simply would not be able to make the change we do without your struggle—so thank you. I would also like to thank our Minister for Health and Wellbeing and everyone in his team, who have worked incredibly hard to see this election commitment come to fruition. I also want take this opportunity to thank all of the nurses and midwives in our state who work so incredibly hard to keep us safe, to care for us, to keep us calm. Luckily, I myself have only ever had to turn up to an ED a couple of times as an adult. Each time, I have felt that I was allowed to be there, that I was meant to be there and I felt sure that I was going to be getting the service that I needed and the support that I needed. That was in large part because of the nurses.

Back in November 2018, I remember turning up to Flinders hospital with a very sick little toddler whose temperature I could not get down. I had been getting it down with medication for a few days, but at this point there was no way; she was shaking and it scared me so much. I just turned up to Flinders emergency. The triage nurse was incredible. She calmed me down and made me feel like I was a really, really good mum and not just freaking out unnecessarily. I was quickly taken into the paediatric emergency department and the care that we received over the next 24 hours while they ran tests and helped to make her better was just extraordinary, and I am so grateful to those nurses.

I also want to thank the nurses who recently took great care of my dad when he got a pacemaker put in. Now he and my mum both have pacemakers and get to use a different line in security, which mum is really excited about. I actually think it probably takes longer—but they are pretty happy with their pacemakers. I also want to thank Talia at Flinders' neonatal intensive care unit, who is a good friend; my friend Anna, who is a midwife at Flinders as well, so they get to work together; and also the wonderful Maddie, who works in oncology at the RAH. They are some of my favourite nurses and I am very grateful to them, and I am really pleased that these changes are going to make a difference for all of our nurses.

We promised to legislate safe nurse and midwife to patient ratios, and today I am really proud that we are delivering on that promise. We are standing with workers, their union and the community to deliver better health care for South Australians, and I commend this bill to the house.

Mr ELLIS (Narungga) (16:45): I rise to make a brief contribution on this bill and outline some concerns about it and the impact it will have on regional hospitals. From the outset, I would like to thank the government and the ministerial office for the briefing that I was afforded earlier. It was much appreciated, and they did their best to alleviate my concerns about how this will work in regional South Australia.

When I say I would like to put some concerns on the record about this bill, it is not about the inspiration behind the bill and it is not an indictment on the nurse ratio that will be implemented as a result of it—that, I think, will be a good thing. I have dedicated quite a bit of my time as the member for Narungga attempting to improve the standard of care in regional South Australia, and I think a mandated level of nurse to patient ratio will assist in making that an improved outcome. I look forward to seeing how that will work and the impact it will have as time progresses, but I do want to raise some concerns about the practicalities of staffing a regional hospital with increased nursing numbers.

I am on a HAC that spans across three regional hospitals, representing the Wallaroo, Maitland and Yorketown hospitals. We meet monthly for each of them, and at each of those meetings a large focus of the presentation by the directors of nursing is about the difficulties in attracting nursing staff to their hospitals. We always mention it at every single meeting, and it is always a work in progress. I do not recall, perhaps with one exception, ever being told that they were at full quota and had suspended their search for further nurses. I imagine that it is an ongoing battle for all regional hospitals and something that will continue.

One would have to think that if the ratios that are applied as a result of this bill increase the level of staffing that is necessary at all regional hospitals, that problem will become more acute. It would stand to reason that if more nurses are required and there is already difficulty in attracting them to regional hospitals, it will exacerbate that problem and make it all the more difficult for those directors of nursing to fully staff their hospitals.

If we add to that the fact that, again, logically there will be a significant increase in the number of nurses staffing metropolitan hospitals, and that there will be all the more attraction for those who are temporarily staying in regional South Australia to staff our hospitals with the future intent to return to metropolitan Adelaide, this might be their opportunity to vacate their residential placement and return to Adelaide hospitals. So we could have a twofold effect—and again I do not mean to be dramatic or hyperbolic—where the problem of attracting nurses becomes all the more difficult and the problem of retention becomes slightly more difficult as well. That, I think, would be a poor outcome for regional South Australia and would take some fixing and some effort to reverse.

These are not necessarily my own thoughts. These are thoughts that I have taken the time to research and have lifted from the health petition inquiry that I was able to instigate recently and the submissions that were made by various parties in line with that. You may recall that I presented a petition to this place that had near-on 11,000 signatures some time ago, thereby passing the 10,000-signature threshold and triggering an inquiry that was conducted by the Economic and Finance Committee.

I have had a quick perusal of the submissions that were made to that process and lifted out a few that lend themselves as evidence to the fact that it is extraordinarily difficult to fully staff regional hospitals already. These examples, or the couple that I am going to read out as part of this presentation, are specifically focused on the Wallaroo Hospital, which is a great passion of mine to try to increase.

From the outset, I want to be transparent and reveal that I might be conflating different areas of nursing. There will be some statistics here that refer to the emergency department but I would like to think that it paints a broader picture of the difficulties in staffing regional hospitals. While these facts may not be directly relevant because this ratio does not apply, as I understand it, to the emergency department, I think it still paints a picture about the difficulties that our hospitals have in fully staffing their workforce. I read from the Australian Nursing and Midwifery Federation submission to the health petition inquiry that I instigated, which states:

Since 2021, patient presentations in the Wallaroo Emergency Department (ED) have increased by 10.5% [according to the] Australian Institute of Health and Welfare (AIHW), 2024 [that has created] additional staffing pressures.

Despite these significant increases, staffing levels have not been adjusted accordingly, resulting in understaffing and inability to meet the required nurse-to-patient ratios.

That is a quote from the ANMF submission.

So if since 2021 the patient presentations to the ED have increased by 10½ per cent but we have not been able to increase staffing levels to meet that additional demand, I have some fear that we will not therefore be able to increase our staffing as a result of these ratios. I go on to read from the same submission, with a real-world example, as I understand it, provided in it, which states:

Staff at Wallaroo Hospital have repeatedly raised concerns in relation to inadequate staffing levels to safely manage the patients within their care.

Examples provided by the staff included:

15 patients on the ward—with 3 staff members available to accommodate them.

Pressure from the Emergency Department to accept more patients to the ward as that department was under excessive demand.

Elective theatre lists continuing, and ward staff were compelled to accept patients early which has significant safety concerns about the assessment and management of potentially high acuity cases.

There we have further evidence in the ANMF submission of the extraordinary demand on (a) hospital services and (b) the nursing staff required there to treat them. I go on again with two more excerpts from this submission. This again is referencing the fatigue and burnout that is being experienced among nursing and midwifery staff across both metropolitan and rural sites, and it states:

Wallaroo Theatre staff have reported the following:

Staff are reporting working up to 16 hours per day due to excessive non-emergency theatre cases being consistently added to the end of full theatre lists.

Excessive overtime contributes to the fatigue and burnout…

That is again, presumably, because of the difficulties in fully staffing the Wallaroo Hospital.

They are a couple of examples from the ANMF submission that I think highlight the difficulties in fully staffing the hospital, and one would presume those difficulties will continue once these ratios are implemented.

I did write to the minister post election—but I do not have a date in front of me—about evidence that I was given by nursing staff at the Wallaroo Hospital. They came to see me and reported that nurse rostering had been reduced in June 2021 for some reason and they were keen to have that reviewed and increased again.

I will be seeking information in the committee stage about the current nursing levels in the Wallaroo Hospital and other hospitals in my electorate and whether those nursing levels will be maintained as we move forward into a legislated nurse-to-patient ratio because we are finding that there is significant strain on our nursing staff in regional South Australia. If we are going to make it even harder with more nurses leaving, theoretically, and fewer coming, again theoretically, it will make that challenge all the more difficult. I will be seeking those numbers and following through in the committee stage.

I wanted to put those fears on the record. The submissions to my health petition inquiry have been most helpful and outlined some significant concerns about the staffing of hospitals in regional South Australia, but I want to reiterate that I think the overall aim of this bill is a good thing. To have a minimum level of care mandated and legislated will provide wonderful benefits, if it is able to be reached.

My fear, and the fear that I will attempt to fully alleviate through the committee stage, is it will become an impossible task for some regional hospitals to meet their legislative requirements and result in either the shuttering of hospital doors or the failure of the LHN to meet the legislative requirement that they are compelled to meet. I look forward to following debate and I look forward to asking some questions in committee.

Ms THOMPSON (Davenport) (16:54): I, too, rise today to speak in strong support of the Nurse and Midwife to Patient Ratios Bill 2025. This is landmark legislation. For the very first time in South Australia, safe staffing levels will be enshrined in law across our public hospitals. We know that when you or your loved one goes to hospital, the most important thing is trust: trust that there will be enough nurses and midwives on shift to keep you safe, to provide timely care and to notice when something goes wrong. This bill ensures that that trust is backed by law.

Safe care depends on safe staffing. Every nurse and midwife in our hospitals will tell you the same thing: when ratios blow out, care is compromised. Patients will wait longer for pain relief, call bells will take longer to be answered, and the risk of complications increases. On the other hand, the evidence—evidence is something that those on this side pay close attention to—both here and overseas is crystal clear: legislated ratios save lives. They improve patient outcomes, they reduce readmissions, and they support staff wellbeing. This bill is not just about numbers on a page: it is about giving our nurses and our midwives the time to do their jobs properly and with the quality of care that they want to be able to deliver.

The bill sets out clear minimum nurse and midwife to patient ratios across key clinical areas. In our largest metropolitan hospitals—Flinders, the Royal Adelaide, Lyell McEwin and the Women's and Children's—general medical and surgical wards will have one nurse for every four patients, plus a nurse in charge during the day. At night, the ratio will be one to eight, plus a nurse in charge. Other metropolitan hospitals, like Modbury, Noarlunga and The QEH, will follow a very similar standard. Regional hospitals, such as Port Lincoln and Southern Fleurieu, will also benefit, with clear minimum ratios that reflect the different scale of those services but still guarantee safe care.

In specialist areas, like coronary care, we are setting some of the strongest standards: one nurse for every two patients during the day and one for every three overnight, no matter which hospital you are in. Antenatal wards will require one midwife for every four patients during the day and one to six overnight, something that they have been fighting for for a very long time. For a category 1 hospital, like Flinders Medical Centre in my electorate of Davenport, this means real, measurable improvements. Families in southern Adelaide can know that, when their loved one is admitted to Flinders, there will be enough nurses on the ward to care for them safely.

This bill is modelled on the successful Victorian approach but adapted to South Australians' needs. Victoria's experience has shown that legislated ratios do not just work on paper, they work in practice. They provide certainty for patients, for staff and for the hospital administrators. By legislating these standards, we move away from ad hoc staffing and ensure that, no matter the shift, no matter the ward, South Australians can expect safe minimum staffing.

We value our nurses and our midwives. They make up nearly half of our state's entire healthcare workforce. They are the backbone of our hospitals, our clinics and aged-care services, yet too often they are stretched to breaking point, covering too many patients, picking up too many shifts, carrying the emotional burden of impossible workloads. This legislation is recognition of their dedication. It gives them the support that they need to do their jobs safely and sustainably. Since coming to office, the Malinauskas government has already recruited more than 1,400 additional full-time equivalent nurses. These new laws build on that commitment, ensuring those extra hands are fairly distributed and that every ward meets safe minimums.

We know this is a major reform and it will be implemented carefully and responsibly. There will be a two-year rollout period, giving our local health networks time to recruit and reconfigure staffing. During this period there will be a moratorium on noncompliance, but after that the rules are clear: deliberate or systemic breaches can attract penalties of up to $10,000, enforced through the South Australian Employment Tribunal. That balance is important, supporting hospitals to adapt but making clear that these standards are not optional.

I want to take this time to acknowledge the tireless advocacy of the Australian Nursing and Midwifery Federation, and particularly Adjunct Associate Professor Elizabeth Dabars AM. For years they have championed this reform with passion and persistence. Their message has been consistent: safe staffing saves lives. This bill is the direct result of that advocacy and of a government that is willing to listen.

In my community, I have heard from countless families about the difference that nurse to patient ratios will make. There are too many stories about elderly people waiting too long for help with things like getting out of bed because nurses are run off their feet. A local mum told me of the reassurance that she felt when a midwife had the time to sit with her through a difficult labour. This is a reminder that safe staffing is not just about medical outcomes but also about dignity, care and compassion.

I remember myself, when I had my first child, the extra time that the midwife spent with me after Lara was born. I was a very nervous and anxious new mum and it made a huge difference. They take you through things like breastfeeding for the first time and even give you a break. They would take the baby away for a few hours and give you a chance to catch up on some sleep. They would not be able to do that if they did not have enough staff on the floor to provide that kind of quality care. These are the real human outcomes behind the numbers.

Ultimately, this bill is an investment in the strength and resilience of our health system. With clear minimum staffing, we reduce burnout, we improve retention and we make nursing and midwifery attractive professions for the next generation. That matters because we know that the demand on our health system will only grow. An ageing population, increasing complexity of care and greater expectations of our hospitals mean we must plan now to ensure sustainability into the future, and that is what this government does: it plans for the future.

This bill is a promise kept. At the last election, the Malinauskas Labor government committed to introducing mandated staffing ratios, and today we deliver. It is a win for patients, a win for nurses and midwives, and a win for the future of our health system. By legislating nurse and midwife to patient ratios, we are guaranteeing that every South Australian, no matter where they live, can access safe, high-quality care. I commend the bill to the house.

Mr PEDERICK (Hammond) (17:02): I rise to speak to the Nurse and Midwife to Patient Ratios Bill 2025, which was introduced by the health minister on 3 September. This bill establishes a minimum requirement for the number of nurses or midwives per patient in public hospitals across South Australia over a two-year rollout period. There is a range of minimum requirements, and I will go through some of that in a moment, which is in schedule 1, part 2 of the bill.

I note the very serious advocacy of the Australian Nursing and Midwifery Federation, which supports the bill in full and has not moved for any amendments. Elizabeth Dabars, who has been mentioned in here previously, has a reasonable knowledge of country health. She was born in Murray Bridge and she has been a strong advocate for nurses and midwives for a long time.

As the member for Narungga and other members on this side of the house have put very well, it is one thing to have a legislated outcome but it is about people on the ground, and those of us who live in the country, whether we are getting feedback from people who work in the health system or whether we are visiting people in hospital, see that staffing levels are very hard to keep. That is not a criticism of the local nurses and doctors. We are short of doctors in the bush, and we are short of nurses.

Something we need to raise during the committee stage is to note that the government indicated that over 1,400 nurses have been hired since this Labor government came into office in 2022. I would like to know how many of those are stationed in country areas, from Mount Gambier through to Ceduna and beyond. You look at little hospitals across the state, whether in Penola, Naracoorte, on the West Coast or, as the member for Narungga indicated, in Wallaroo. How easy is it to make sure that those shifts are filled?

We do not want perverse outcomes of this legislation. I certainly support the intent of the legislation. I think it is good legislation in that regard, but at the end of the day you need to have human resources. That is as basic as it gets. You need to have the actual human resources that you can call in to do the job as needed. Like in any occupation, people get sick and cannot turn up for a shift, so you have to be able to backfill. Whether that is local staff or agency staff, you have to be able to access the feet on the ground to do the vital health work that nurses and midwives do.

In line with that, we have to have adequate facilities. Especially in regional South Australia, there are a lot of facilities that need upgrading, which do not have the services of the city. I guess we get used to that, over time. Noting that obviously this bill is partly concerned with midwives, Murray Bridge needs a full midwifery section upgrade. It is cramped, it is out of date and it needs a complete rebuild to bring it up to speed. Over the next 30 to 40 years there will be more than 50,000 people extra coming into Murray Bridge, which already has a population of over 22,000.

We need facilities, and we certainly need good facilities for people to work in. Previous to the 2018 election, I worked hard to get a policy in place to get a new emergency department built at Murray Bridge. When we stood at the opening of that $7 million facility, it was a very proud moment indeed. They certainly have multiple treatment rooms. I think there are about nine or 10 treatment rooms in there.

Sadly, when things get pretty busy in the hospital, some of those rooms are used for inpatients, but it is a far safer situation than what we used to have at Murray Bridge, where essentially there would be three beds just with curtains between them. The so-called safe room, when it hit the fan, when something went wrong, was a glass room so you could see what was going on, but it was only one small area where doctors, nurses, attendants could go in, and then they could not get out again because there was one entry and one exit. I must say that emergency room is fantastic, as is the whole emergency department.

I commend all the people who work in health right across the state but especially those in the bush. It gets back to the ambulance volunteers and everyone involved, who have that great call on them to deliver services not just to country people but city people who may be touring the area, participating in sport and needing those good outcomes.

We certainly acknowledge that not everything can be done in country hospitals and obviously many of the specialties are required in Adelaide. I think it is a fairly common number that in Adelaide hospitals probably 30 per cent of the patients are regional patients coming up for various care and obviously we would love to see more of that care delivered locally.

It is tough getting that care when you need it in a timely way at times, and I have raised over the last few months, as has the member for Frome and others, the helipads that are not in use right across country South Australia. It has taken far too long for their upgrades to be approved and for them to be used. I find this completely outrageous. We cannot get an answer out of the health minister why they are not being used.

Certainly in regard to my two at Mannum and Murray Bridge, they were essentially signed off by the health department in April after shutting services in September last year. That is 12 months without retrievals from those helipads. Yes, there are optional sites. There is Pallamana at Murray Bridge or the Mannum oval, but you have to load people up in an ambulance, tie an ambulance up, take up valuable time when they could be essentially almost into Adelaide on the helicopter.

Obviously having my office in Murray Bridge I used to hear the helicopters pretty well every day and the MedSTAR team coming in. The MedSTAR pilots and the health crews do a magnificent job, but they are hampered by some absolute idiocy. I do not know what it is and I would love to have some answers come from the health minister as to what is going on.

These helipads were built specifically for use and Health have signed off on them, but for whatever reason they are not being operated. The MedSTAR pilots know what they are doing and they will land on roads—I have seen a helicopter on a road. They will land in paddocks next to an accident and they will deliver that treatment and get people in the air to the city where they need to be.

Out of the 13 helipads in the state, the ones that are open are Wallaroo, Balaklava, Kingscote on Kangaroo Island and Meningie, although someone as recently as this morning indicated that Meningie was shut down because the lights were not working or something. The sad thing is Clare, Kapunda, Loxton, Mannum, Murray Bridge, Port Broughton, Port Pirie, the Riverland general at Berri, and Victor Harbor are not operating because of something ridiculous that is happening.

This is an issue and this reflects on outcomes for country health. It is alright for people to come in here and say, 'We want the right health outcomes for people across the state and we have delivered'—as the government is saying—'more people to deliver those services,' but we want outcomes too. We want to know that if we need to get on that chopper, it will turn up, as those crews do, and take us to that vital emergency care to get the treatment that we need.

Alongside is the Royal Flying Doctor Service, giving great care and service across South Australia and the rest of Australia in getting people to that vital care they need. People would be surprised at the number of flights that the Royal Flying Doctor Service do getting people to that care and the doctors, the nurses and paramedics who work with them.

When I look over my life, it is probably close to a handful of times, at least, that I have had to go to emergency for various things. Tailem Bend did a great job as did Murray Bridge in the new emergency department. It was great service by the team, and I am still here so I guess that is a reasonable outcome—some people may not think so.

That massive service is not to be denied, especially when you can see on a busy night, as I did, multiple incidents coming in and people just getting on with the job. They were under the hammer but they were getting on with the job; they were truly professional and made sure they could give that vital treatment that people needed to get.

In general, we just need to see more staffing: we need to see more doctors in regional health and we need to see the nurses in regional health. It is to be noted that Strathalbyn does not have a properly functioning emergency department. Mannum and Murray Bridge do, obviously, but it is just so hard to get full-blown, decent health services for people in the regions, so there will be a lot of questions asked during the committee stage about those outcomes.

It should also be noted that the Nurses and Midwifery Federation represents over 25,000 nurses, midwives and personal care workers in South Australia, and I salute them all for the work they do. It is vital work, it is hands on work, especially when you need a caring voice to talk to. It is a real lift when you are in emergency care, because obviously you are in a situation where you could be looking at a few vulnerabilities yourself.

Nurse to patient ratios are legislated in Victoria, Queensland, New South Wales and Western Australia, and this bill is largely modelled on the ratio system in Victoria. It is noted that a study published in The Lancet on the Queensland experience concluded that it is a feasible approach to have legislated numbers of staff to improve nurse staffing and patient outcomes, with a good return on investment.

It has already been discussed on the floor here today that there are a number of variables in the ratio requirements, and these are based on the type of patient care being provided as well as the hospital site. SA Health and the nurses' union both advised that these sites are determined in accordance with the volume of patients and acuity. There are essentially four hospital categories in the bill. In category 1 you obviously have Flinders Medical Centre, the Lyell McEwin, the Royal Adelaide and the Women's and Children's Hospital, the main hospitals here in Adelaide. The category 2 sites are the Modbury Hospital, Noarlunga Hospital and the Queen Elizabeth Hospital.

Then you get down to the category 3 hospital sites: the Riverland General Hospital at Berri, Mount Gambier and Districts Health Service, Whyalla Hospital, Port Lincoln Health Service, Gawler Health Service, Mount Barker Hospital, Murray Bridge Hospital, Port Augusta Hospital, Port Pirie Regional Health Service and the Southern Fleurieu Health Service. Then you get to category 4 sites—and, as the member for Frome indicated, there are some sites in her electorate and some across the state as well that are not included in these lists—which include the Naracoorte Health Service and Wallaroo Hospital and Health Service. There are separate requirements for smaller hospitals, and the ratio required varies according to the categorisation of the hospital, the type of care—there are 14 categories in the bill—and the shift.

For antenatal wards, morning and afternoon shifts, the ratio is one midwife for every four patients and one midwife or nurse-in-charge, compared to one midwife for every six patients on the night shift. Acute stroke wards require one nurse for every three patients and a nurse-in-charge, compared to geriatric evaluation and management units, which require one nurse for every five patients and one nurse-in-charge on morning shifts, one nurse to six patients and one nurse-in-charge for the afternoon shift, and one nurse for every 10 patients and one nurse-in-charge for the night shift.

General medical and surgical ward ratios depend largely on the category of the hospital site, as I indicated earlier. Small hospitals are required to have at least one registered nurse and one other nurse or midwife on all shifts. These categories have all been discussed with the Nurses and Midwifery Federation and the government, and the union supports the ratios for each.

Certainly, members over here have discussed the issues of workforce in the regions, and it is something about which there will be multiple questions raised in committee. I think all those questions will well and truly be valid, because it is difficult to fill shifts. Sometimes people are looking at a new career and they feel a bit hesitant if they were raised in the city before they come to the country. But then they get out there, and the next thing is that they start a new life. It reminds me of situations where nurses or teachers, as two examples, used to get posted to Eyre Peninsula. They would think, 'We will do our time and come home.' Well, they ended up not coming home and ended up becoming grandparents and having families where they landed. That does not happen all the time, obviously, but some people just see the light of how good it is working in the bush.

Obviously, we have talked about breaches of the bill that will be enacted. For example, if there is an emergency that could not have been anticipated there will not be action taken. If a breach is proven, the civil penalty for deliberately and systematically breaking the rules goes through the South Australian Employment Court, and the fine of $10,000 goes back to the Treasury. Treasury funds health to the tune of now about $9 billion, so they get another $10,000, I guess.

It is good to see that there will be a two-year transition period, because we will need to see, in an ongoing sense, how staff will be recruited. As I indicated, it is great to see 1,400 extra nurses, but I want to know how many of those have gone to regional hospitals and country hospitals to service those of us in the regions. Yes, we do need the services of nurses and midwives in the city because, literally, we cannot supply all the health functions in the country. We would love to see more specialists and services coming out, and that kind of thing, but, in saying that, if that is not possible those of us in the country just want fast access to vital care in the city, whether it is for cardiac health and stroke health or whether it is for major accidents, where it can literally be about life or death.

When you see a car that has rolled over and the helicopter is parked there on the road or in the paddock, and you see the local CFS cutting the roof off the car so they can deliver vital life-saving care, you know that the right things are happening and those people who need that care can be delivered to Adelaide in a hurry. We need to make sure that that vital helicopter service can be provided, not just away from hospitals but from those vital helipads at country hospitals. I commend the bill.

Mrs PEARCE (King) (17:22): I am so pleased to rise today to speak on the Nurse and Midwife to Patient Ratios Bill 2025. When the Minister for Health introduced this historic legislation in this place, our government delivered on our promise to South Australia's incredible nurses and midwives to introduce staff-to-patient ratios that will help them provide the best and safest care to their patients. It also confirms our government's continued commitment to ensuring the safety of our nurses and midwives within our public health system.

Since being elected, the Malinauskas government has already recruited more than 1,460 full-time equivalent nurses, above attrition, across our public health system, which will help to support the implementation of these new ratios. We have seen how successful nurse and midwife to patient ratios have been in Victoria, and this legislation will implement it here, tailored to the South Australian public health system.

Our nurses and our midwives are the beating heart of our public health system. They are often the unsung heroes of some of the most significant moments in our lives. They are there when your life begins, guiding families through pregnancy and labour with quiet strength and compassion. They are by our sides in times of crisis, comforting us through illness, injury and uncertainty. Whether it is the joy of birth, the devastation of pregnancy loss, the fear of diagnosis, or relief of recovery, nurses and midwives are always present, steady and skilled, ready to provide not just medical assistance but emotional support when we need it the most.

They are workers like my beautiful stepmum, Deb. She was a dedicated midwife and a force of good in not just my family's life but the lives of many families in her local community. She devoted her career to looking after new mothers and families with the highest level of compassion and professionalism. Later in life, she was supporting older people to live independently at home, which is especially special, considering she was providing this service in the Port Pirie Regional Health Service area, helping to connect regional people with those all-important services to keep healthy, fit and well. Even in her retirement, her working life legacy lives on in every life she helped bring into this world and every family she supported along the way.

There are also workers like the lovely Liyu. I had the pleasure of hosting Liyu in parliament earlier this year for international nurses and midwives day. Liyu is a hardworking, young and proud northern suburbs girl, who has spent many years caring for patients at the Lyell McEwin Hospital. Although Liyu is now lending her invaluable skills and knowledge to another public hospital, she has well and truly left her mark on the public health system in the northern suburbs. Staffing ratios, like the ones our government is introducing to parliament, will provide support to nurses like Liyu, so that they continue to provide safe and sustainable care to their patients.

Our government has worked closely with the South Australian branch of the Australian Nursing and Midwifery Federation throughout the drafting of this legislation, ensuring that the voices of frontline healthcare workers were not only heard but genuinely valued. This collaboration reflects a shared commitment to safer staffing levels, better working conditions and ultimately better care for patients. It is a strong example of what can be achieved when policymakers and healthcare professionals come together with a common goal.

Under these new laws, Adelaide's four largest metropolitan hospitals, including the Lyell McEwin Hospital, will be required to have one nurse for every four patients, along with a nurse in charge, in general medical and surgical wards during morning and afternoon shifts. For night shifts, one nurse is required for every eight patients, with a nurse in charge. Other hospitals, including Modbury Hospital, will be required to have the aforementioned ratios for morning and night shifts, but with one nurse for every five patients, with a nurse in charge, for afternoon shifts.

Across all public hospitals, one nurse for every two patients and one for every three patients overnight is required in a coronary care unit, and one midwife for every four patients and one for every six patients overnight is required in an antenatal ward. Safe care for patients depends on safe staffing. Legislating staff ratios is an important step in supporting our hardworking nurses and midwives and ensuring every South Australian receives high-quality care.

I am really grateful to have quite a few nurses in my life; I have grown up with quite a few. Some are still working in the regional health system, some are working in emergency departments and some bounce around to wherever they are needed. All are absolutely incredible, and I thank all for the work that they do, have done and will continue to do to support health care in our state. We are showing our appreciation as well, and we remain firmly committed to supporting nurses and midwives like them through our actions.

In delivering on this election commitment, and investing in safe staffing ratios, we are building a stronger, more sustainable healthcare system. This legislation is about giving them the respect, resources and support they deserve, now and into the future. I commend this bill to the house.

Mr DIGHTON (Black) (17:29): I rise to speak to the Nurse and Midwife to Patient Ratios Bill 2025. It is important to note that the Nurse and Midwife to Patient Ratios Bill represents the first time in South Australia that nurse and midwife to patient ratios will be enshrined in legislation. I seek leave to continue my remarks.

Leave granted; debate adjourned.

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