Wednesday, 22 February 2023
Health Legislation Amendment (Information Sharing) Bill 2023
Health Legislation Amendment (Information Sharing) Bill 2023
Debate resumed on motion of Mary-Anne Thomas:
That this bill be now read a second time.
Emma KEALY (Lowan) (10:41): It is my honour today to rise to speak on the Health Legislation Amendment (Information Sharing) Bill 2023. It is somewhat a matter of déjà vu, because we debated very, very similar legislation in the last term of Parliament. In fact I had a look back through Hansard and I was very, very tempted to just simply table the lead speech that I offered in the last term of Parliament to perhaps move things along more promptly today. However, I will not give the entire Parliament that opportunity; they may go back to my previous Hansard contribution. There are a number of elements which have raised deep concern within the wider community. These are concerns that were raised during the last iteration of the bill in the previous Parliament, but as they were not addressed at that time – the bill was not passed by the upper house in the last term – I would again like to prosecute the reasons why these elements and weaknesses of the bill are of key concern to Victorians, whether in a professional capacity or in a personal capacity.
Of course we completely understand the importance of sharing health information in a timely and accurate way. As I have mentioned many times in this place, I have a background in health. I am a biomedical scientist by training. I have worked extensively in pathology, but I have also worked through administration of health services within the state and interstate as well. One of the key barriers to providing timely and appropriate care and where some errors can come into play is where information about a patient is not effectively and efficiently transferred between practitioners who are caring for an individual. There are some ways that in Victoria we have looked to work around that, and I would like to congratulate my former employer and one of the hospitals in my electorate, Western District Health Service, for their incredible work when it comes to taking the next step and leaping ahead and being a real leader when it comes to best practice in minimising risk for patients and also delivering high-quality care. Many, many years ago, over 10 years ago, they put in place a type of information sharing whereby the ambulance report could be automatically uploaded into the hospital’s health information record electronically so that during that patient’s hospital stay they could see how the patient was found by Ambulance Victoria, what treatment was provided and what their initial summary was of the health condition of that individual. In some ways health services have already been able to deliver in a small way towards providing intersections in sharing information about patients in an appropriate and timely way.
But there is much more that needs to be done. I was working within the health system when we had that horrible rollout, which took about a decade and then was scrapped, of HealthSMART. There was a grant announcement. There was millions of dollars tagged to it – I think it was $437 million from memory – back in the 2000s. It was about just trying to get a single IT platform to be able to unify health information. But the government of the day did not consult with health services and as a result more and more and more money was poured into the system. Finally it was scrapped because it simply was not fit for purpose and was not what hospitals were looking for.
So while the legislative framework is absolutely essential when it comes to sharing health information, it is also essential that we have infrastructure that can support that, and at this point in time we still have no funding towards a unified health information system. We have no funding dedicated to creating a portal that would effectively share information – just grabbing some IT lingo from my past history – and would communicate information in health level 7 or a similar format, that would enable different IT systems to communicate in a way that does not put patient information at risk and the integrity of that information at risk.
There are elements of this bill which absolutely we strongly support, and we strongly support all health professionals being able to do their very best in their own communities. We know that at the moment there are critical issues across health services on every front in Victoria. I would like to put on record my thanks and appreciation for all health workers across the state. It does not matter whether you are one of the first responders, the paramedics – last year my little girl was in a critical accident, and the paramedics were absolutely fantastic in the support they were able to provide to my family, and I have reiterated my thanks to them personally on a number of occasions. But I know if anybody has ever had to call 000, they hope that it is answered in an appropriate time frame and an ambulance turns up on time. But when the staff are there, there is absolutely no doubt they care, they are very good at what they do and everybody is doing their very, very best under difficult circumstances.
We also have critical issues in health services across the state simply in delivering the services that the community expects them to deliver. Right at this very moment in time there is a very angry crowd outside Grampians Health in Stawell who have been locked out of a community meeting which was about a chat with the CEO. There are deep concerns in that community around the contract for a loved GP anaesthetist, Dr Adnan Rasheed. There has been a cost-cutting exercise put in place where the government are looking to change the contract for this GP anaesthetist – and we know GP anaesthetists are as rare as hen’s teeth. They are looking at making significant changes to his contract which would not only impact how he operates and the hours that he does but would also critically impact the conditions that he would enjoy and has enjoyed for almost 15 years in that local community. It represents about a 50 per cent cut to his income. There will be some out there that say, ‘Who cares? Doctors earn a lot of money.’ Well, you know what: I care, and that community cares. They should not be locked out of a meeting. They should be heard, that local community. There is absolutely no reason why a contract which has been in place for 15-plus years should be cut when the GP is very, very good, when they service that community and when there is community support for them. And the only response that we get back is, ‘Well, he’s moving away for family reasons.’ That is inherently incorrect. It is a lie that has been circulated.
I again urge the Minister for Health to step up in this contract negotiation and ensure that a beloved GP, when GPs are in such short supply, does not leave the community simply because of stubbornness from a public health service who are trying to cut funding. If there has been a change to the federal funding agreement, hold the federal Labor government to account. If there is a change locally about the funding that is provided to Grampians Health, and particularly to the Stawell campus, then be up-front and honest with the community and say, ‘This Labor government is cutting funding to this hospital, and as a result you’re not going to have this GP anaesthetist.’ But be up-front with the community and meet with them and do not lock them out of community meetings.
There are two main elements of this legislation about which the Liberals and Nationals have significant concerns. One is specifically around the provision for all information to be uploaded to the system on a mandatory basis with there not being either an opt-in or an opt-out element. This includes either specific information which you might find sensitive if it was available to be accessed by everybody within the health sector in Victoria or a person’s personal view that they do not want any of their health information uploaded into a whole-of-health information system. The second element that there is deep concern in the community around is that this legislation specifically exempts the Department of Health from an administrative perspective from being subjected to freedom-of-information requests.
These are really key issues. They were both raised during the last iteration of the bill in the 59th Parliament of Victoria. I do want to go into further detail around them, because in my view these are the key sticking points that will make the difference in Victoria getting the health information sharing system, the legislative framework, that it needs to be able to share information about patients in a timely way but also getting the balance right when it comes to respecting a patient’s individual autonomy around the information that is shared very widely and then also ensuring there is a level of scrutiny available so that patients have got a level of security and transparency in understanding who is accessing their record, when they are accessing it and perhaps even why that person would be accessing it.
I would like to refer to a media release from the Law Institute of Victoria, because I think that they have articulated very neatly what the issues are around the specific elements of the bill. They are concerned specifically – and I will break it up into those two elements – about the autonomy that is expected for patients in sharing of their health information and of course, secondly, as I have referred to, the exemption of the department from the scheme being FOI-able. I refer to the Law Institute of Victoria media release which is dated 15 February 2023 and a quote that is in it, which is:
Patient autonomy must be front of mind in any health legislation being put forward by government to protect patients’ rights. The implementation of an opt-out scheme would place choice back in the patients’ hands about the healthcare they receive in the Victorian public health system.
Patients must have the right to say who can access their health information – even if this means their health information will not be shared under the scheme. Patient autonomy is a fundamental human right: it’s the same principle that allows a patient to refuse medical treatment.
There are a number of examples that I would like to put on the record that would help to explain why there are wider concerns around this. It is not just the Law Institute of Victoria; I have had similar feedback from community health services and hospitals. I think if we all put ourselves in that position, knowing ourselves, our own history and our own records which are available in packages in different health services across the state but also our family members and other people who are close to us, we understand that some of that information is very generic. It is not that sensitive. It would not make a difference if people knew what that result was or not. But there is other information which is very sensitive to us for different reasons.
I specifically refer to examples around mental health. If at this point in time you have the courage – because it does take a level of courage – to say, ‘I have got a mental health issue, something is not right. I know that I cannot do this alone any longer. I want to reach out and I want to receive some help’, you go to a public health service and you know that there will be records retained so that next time you go there is a background and there is a history. There is a requirement to collect that information and document it in a certain way. However, you do not necessarily want the relationship that you have got with your psychiatrist, for example, or psychologist – that information – to be shared beyond that individual practitioner, with whom you have a personal relationship. There is a level of trust that is required between the patient and their practitioner that may be impeded if there is therefore a secondary understanding that ‘This information may be shared beyond just me and my practitioner’, and that is something that is enormously sensitive and something that should be relevant to each and every one of us when we consider we are in the midst of the Royal Commission into Victoria’s Mental Health System recommendations around mental health being implemented at this point in time. I do not believe that as a government we should put any barriers in place in people having the confidence to be able to access mental health care if they have an underlying insecurity that that information may be utilised against them in the future. That is because this information would be available, through this legislation, to the entire health system. While you may seek some support from, as I said, mental health services, if you apply for a job in the health sector in the future, you may feel like this is going to be used against you. You may feel like this information could be accessed inappropriately and that you would not be eligible to get a job, and that may mean that somebody does not seek that mental health support because they are worried about who will access it.
This comes to the other element which I have raised about the concerns, which is that there is no way to FOI who has accessed your health information. As we know, under this legislation the past three years of health records will be uploaded into the information-sharing system. We cannot undo time, so there may be people who have sought assistance and support for a mental health issue who will be put under increasing pressure, which may cause anxiety or depression, because they think, ‘Oh, my gosh, I had what I thought was a confidential discussion between myself and my healthcare practitioner, and now my employer, my friends, my ex-husband, my sexual abuser may be able to access this information, with there being no way for me being able to understand when they accessed it, if they accessed it or other family members accessed it, and how that information may be used. Was it printed? Was it retained for another time?’
This is something that is of concern not just to the mental health sector but to so many other aspects of services that are provided by our health and community health sector. It may be information about an abortion that was sought by a woman and how that information may be shared widely and used against them. It may be information about a sexual assault that they experienced either as an adult or as a child and they do not want to be used against them in the future or even to be understood or known at a wider community level. It could be information that could be used against somebody in a legal perspective in terms of a divorce settlement where it is one of those very, very spiteful cases where children are involved and there may be discussion around who has got custody of a child. Then within the health system you could see that somebody has been treated for alcoholism, or, as community health centres are included in this legislation, that they have been using a medically supervised injecting room.
This is critical information, and I am hopeful that members of the government are able to see why there are concerns about this. This is a pragmatic approach, it is a constructive approach; it is not about obstructing the legislation in any way at all. We cannot have legislation in place that acts as a deterrent for people to access healthcare support. We cannot do that in the short term. We also cannot put a system in place that can very likely create deep anxiety, concern and even depression amongst individuals who have records already and who will now have this worry that this information may be accessible by the entire health network in Victoria.
I know, and I would like to reiterate, that our health professionals are so professional in many, many ways in how they deliver their work. This is not questioning the entire health sector. It would be inflammatory and entirely inaccurate to try to prosecute that case and try to say that health professionals share information willingly. We all know that is not the case. I have worked in the sector; I know that for the most part we have good eggs. However, there is the occasion, particularly in those high-intensity situations that are highly emotional where, if there is an opportunity for somebody to access or to check information – that they want to know out of curiosity or which may be advantageous to them for personal gain – unfortunately, as we are human, some people might seek to take that opportunity, particularly with the understanding that that inappropriate access to information would never ever come under scrutiny because it is not FOI-able.
I understand there is a level of scrutiny over this legislation. However, it is about the individual and their right to be able to see who has accessed their information. I therefore would like to reiterate the importance of this scheme being FOI-able, and that includes all those elements I have referred to. It includes the electronic tracking and understanding which logins have searched for specific patient records and at what time. This is a minimum human right that we all have in Victoria, to understand who is accessing our information, and no more so than when it comes to a health record – a community record, an ambulance record or of course, as is specifically included in this legislation, the Victorian Collaborative Centre for Mental Health and Wellbeing. It was actually confirmed by the government that community health services are in, which is where our concern for the medical supervised injecting room comes into play.
This is of course something that comes back to the heart of transparency within government. It has never been explained why this would be specifically exempted in the legislation and the administrative elements of the management of the scheme, the health information scheme, would not be FOI-able. So I move:
That all the words after ‘That’ be omitted and replaced with the words:
‘this bill be withdrawn and redrafted to provide for an opt-out provision and for the Department of Health to be subject to freedom of information requests about the scheme’.
We are putting forward a reasoned amendment today. As I have stated, this is not about being obstructionist. It is about constructive improvements to the legislation that would ensure that there is confidence in Victoria’s health system, that information is managed as it should be and that people have options to be able to select whether they will participate in the legislation with all of their information being uploaded. There may be an opportunity for specific elements of people’s health information to be withheld from a whole of health information sharing scheme, which may include specific elements around accessing specific community healthcare or hospital care in relation to sexual assaults, reproductive health treatments, treatment for drug and alcohol support or something like utilising a public health service like an injecting room or other similar drug treatment programs like a methadone program or the like. We also of course would like to support that FOI-able element of the legislation and to ensure that there is a level of transparency around who can access that specific information, around when people can access it, who is accessing that information, how often they are accessing it and, where possible, whether they have printed, emailed or reproduced that in some way.
We also have concerns around of course other elements of the legislation. This is specifically around the risks for individuals in relation to all information being available on one database when there has been a history – and a relatively recent history – of increasing amounts of cyber attacks on and hacking into large-scale government systems and private systems as well and that information being published or utilised against individuals for personal gain. This is of great concern, and we know that there is a lot of work going into ensuring there is strong protection for people when it comes to inappropriately accessing private information. Unfortunately, we have seen on occasion within the Victorian government’s own system that there have been cyber attacks and information that has been inappropriately accessed, published or utilised for financial gain or to apply pressure on individuals in a way that has caused an enormous amount of mental harm – and also in some ways financial harm where there have been hacks on the banking system. We have also of course seen hacks in the Medibank system recently. I understand some members of this place have also had their personal information exposed, so many of us have actually seen the impacts of having your personal data hacked. Having one large-scale system which contains all health information for the state does create a far greater risk for that information to be accessed on a widescale level and for much more information to be accessed as a one-stop shop.
As I said at the start of my contribution, there is not any additional financial allocation to the creation of additional cybersecurity around a whole-of-health information system. In the same way, there is also no financial investment in terms of the creation of portals and other communication software that will be required to be able to deliver this system. So that is of great concern.
The other aspect around this is that it does not include health services outside of the public health system. We know of other legislation which has come through this place which has had broader ranging powers than just control of public health services and has included parameters or legislative restrictions and obligations for the private health sector as well. And so while this is being sold as sort of a one-size-fits-all – everyone will have your health information and it will provide far greater medical support for individuals – you will not be able to access some of that really important history. Our GPs are a group of individuals who really have the core overview of our all-of-health histories. This information system will not be speaking with any of the GP platforms that are out there.
It is limited at this stage, and it is not really clear whether it will immediately integrate with My Health Record, the federal government scheme. I would like to refer back to that because we know My Health Record has had many, many stumbles along the way, and there were certainly similar parameters around whether it be an opt-in system, an opt-out system or a mandatory system. This was a debate that was had at a federal level over many years, and different iterations of the program have been put in place. In the end, what we have now is an opt-out system, and so for consistency I believe it would be appropriate that an opt-out system at a similar level of the federal My Health Record be applied to this Victorian health information sharing scheme.
The other concern around what is included and what is not is that it is only restricted to Victorian public health services. My electorate of Lowan abuts the South Australian border, and there are many individuals that seek medical care over in South Australia and, vice versa, a lot of South Australians that come across to Victoria for treatment. We do not see the imaginary line. However, there has not been any work put into the legislative framework and how this will operate in real time in terms of engaging with South Australia and New South Wales in particular, and this may put at risk the communication of health data for people who live close to the border. We know border communities are really overlooked so many times when it comes to design and decisions – which if you live in Melbourne you probably do not even realise is an issue – and it does have a massive impact if you live near a border and have a life and work balance which crosses over that border. I do not think that that has been emphasised more greatly than during the COVID pandemic, where we had border closures which would cut off individuals from their GP, from their chemotherapy. It cut off the funeral director who lived in Victoria from being able to deliver any funeral services in South Australia. It is something that we should be very much aware of, and I am very surprised that the government have not made those efforts to iron out those significant issues before bringing this legislation back before the Parliament.
There is a reason that this legislation stalled last time around. Back in 2021 – 13 October 2021 – I was the lead speaker on this bill in the 59th Parliament of Victoria. The legislation was debated in the upper house; however, when it became very likely that these exact concerns that I have raised today had not been addressed, it never went to a vote. It did not pass. I am very, very surprised that because of that stalling of the legislation in the Legislative Council last time the government have not taken heed that these are serious concerns. While the make-up of the Legislative Council and the Legislative Assembly changed after the election, there are still significant concerns that have not been addressed, which are specifically around opt-out provisions and around the scheme being FOI-able. That is not just the internal information but the external information and the administration of the system that cannot be FOI-able.
That is why today I have put forward a reasoned amendment that the bill be withdrawn and redrafted to provide for an opt-out provision and for the Department of Health to be subject to freedom of information requests about the scheme. I am hopeful that government members will consider some of the points that I have raised today, that you put yourself in that position – your family in that position – where you may have sensitive information you do not want the entirety of the health system to be able to access and that you lobby internally to ensure that between houses this legislation is reviewed and those elements about an opt-out provision and those elements about being able to FOI the scheme and who accesses the scheme are addressed, because if this is not addressed, I do not think that this legislation will pass, which would be not what the health sector want – they want an information-sharing scheme – but also it would take away some of the confidence that Victorians have in accessing public health and mental health services in Victoria.
Vicki WARD (Eltham) (11:11): Thank you, Acting Speaker Settle. It is great to see you in the chair this morning as we talk about the Health Legislation Amendment (Information Sharing) Bill 2023. I have to say – we are at, what, day 3002, I think it is – how terrific it is to be talking about real legislation and work and getting on with it rather than worrying about statues, which really is not the work of government. What is the work of government is making legislation and making decisions that enhance the lives of Victorians, and that is exactly what this legislation will do. It is good to see that we as a government, even 3002 days on, are still creating important and necessary legislation that will continue to improve the lives of every Victorian.
This bill will support safe and high-quality care. It supports several recommendations from Targeting Zero: Supporting the Victorian Hospital System to Eliminate Avoidable Harm and Strengthen the Quality of Care. The bill specifically supports recommendation 4.13.2 that:
The department should adopt a goal of ensuring that, by –
all major hospitals have a fully electronic health record that enables interchange of information with other hospitals.
There are a lot of important outcomes from this legislation. It includes the pathology information system, which means that three new public pathway networks will be created, establishing an authorising environment to enable public pathology services to securely share pathology reports between health services to improve clinical decision-making and improve the quality of care.
You might not think there had been extensive consultation given what the previous speaker said, but I will talk you through the extensive consultation that occurred over a number of months in 2020 on this. It was with hospitals and health services; the health complaints commissioner; the mental health complaints commissioner; the disability services commissioner; the Law Institute of Victoria, which included reference to elder law; and Victoria Legal Aid. It also included clinician and consumer representatives and professional associations and colleges, including the Australian Medical Association and the Australian Nursing and Midwifery Federation. It further included other representative bodies such as the Victorian Healthcare Association, the Australasian Institute of Digital Health and the Office of the Victorian Information Commissioner. That is pretty extensive consultation, I think.
The last few years have shown us how important information sharing needs to be, particularly in urgent situations. I think with COVID, people in this space can understand how if you have had COVID, it is important for whatever medical professional you are seeing to know that, because we know that long COVID is a thing and we still do not fully understand how having COVID can affect your body, affect your organs, affect how you move and affect a whole bunch of things. To be able to have that information at hand so you can start to incorporate that into your understanding of the symptoms that a patient is exhibiting is really important.
I will remind you of 2021 when my dad had to have a triple bypass. My parents live in regional Victoria. I know that those opposite like to pretend that those of us in Melbourne have no connection to the regions, but many of us do; in fact many of us represent regional regions, including the good member for Bass right here. I digress. Anyway, Dad was at Traralgon hospital and they were trying to work out what was going on with him. We only had Dad – Mum was in the waiting room because we had COVID restrictions. I can imagine the difficulty of working with Dad, trying to get from Dad what his medical history has been, going out to the waiting room and talking to Mum, finding out more about Dad’s medical history, going backwards and forwards. Dad ended up getting transferred to Monash.
Again you have that system where you have got people relying on phone calls. They were relying on phone calls to Mum, because again Mum could not be in hospital with Dad because we were in restrictions to keep people safe from COVID. So there are all of these phone calls. There are faxes. I remember standing in this place when we were all losing our minds that the police were still using faxes eight years ago to talk about their information and what was going on. How are we still relying on faxes in our medical system to transmit information? It is interesting when you want to talk about privacy – faxes are not that private. Faxes are not private at all, and there is not a control necessarily on how you manage that privacy when you have a fax come through. So if they were able to just get onto a screen and see what a patient’s medical history has been, they could have understood the medical challenges that my dad had had prior to his bypass. My dad had had fits. My dad had had a whole bunch of things happen to him that were leading to this moment, and they were having to rely on phone calls, on faxes, on anecdotal stories of what my mum could remember, what my dad could remember, to help with his treatment. He received fantastic treatment at Monash, and we are very grateful for it. But it just highlights how important it is to have that access to that information right at your fingertips.
I will talk to you about my own personal experience a couple of weeks ago when I received a dog bite. I had to go to emergency, I thought to just get it cleaned and flushed out – but no, apparently you cut dog bites out, so that meant a night in emergency. I then went into surgery and had the bites taken out and spent another night in hospital. The amount of my own medical history that I had to be able to tell people at every point – and I recognise that there are security checks that you have got to do as you go through: ‘What is your date of birth? What is your name? Are you allergic to anything?’ And you are going to do that whether you have got this information or not. But sitting in emergency I was hearing what was going on around me: hearing the people coming in where English is not their first language, hearing people coming in who have got mental health issues and are not able to say what their condition is or what they need or what they have experienced in the past or what has happened to them. We had an older woman who was clearly in the early stages of dementia who was getting confused. She knew she was in a hospital, but she was confused. She was getting up; she was at risk of falling. She must have come from somewhere where a professional carer was helping and advocating for her very strongly. I give a huge shout-out to that carer, because he did a fantastic job supporting her and advocating for her. But he is not going to know her full medical history, and nor should he necessarily know her full medical history. Again, if you want to be talking about privacy and concerns, this person could have been a casual at wherever she was living. This person could have just been on the night shift and not needed to know her extensive medical history. So by having that resource electronically available to you as healthcare professionals, you can ensure that your patients are getting the right care, you can go through the medications that they have got and understand what is compatible with what – what could actually hurt somebody, what could not. Knowing that they have tried this drug in the past and it has not worked for them or that they have had an adverse reaction is really important.
I will give an example of the guy next to me in emergency, who also had a dog bite but had not come into hospital early enough, and his hand had become the size of a football. He had an allergy to penicillin. People were asking him that, and he was telling them. But then a new nurse came in and I was waiting for them, because you can hear through the curtains. He eventually told her that he had a reaction to penicillin, and they changed what they were doing. There was no near-death experience or anything – I am not trying to dramatise this – but you have got to have that information in real time. You have got to be able to check and check and check again.
This is really important legislation, and this is a good amendment that we are putting through. It is an important amendment to come through. I think it is unfortunate if there are people out there who want to undermine it through creating fear about circumstances that are not happening or are not real, because this is important legislation that will help with the care of people and will also help save lives. This will come into effect in February 2024. There are offences and penalties that relate to unauthorised access, and I think that this is a really important part of the legislation that we all need to understand and accept will help protect patients from the concerns that have been raised by the previous speaker.
People are moving between health services, particularly as bulk billing becomes rarer thanks to the mismanagement of the unfortunate previous Morrison government. I commend the Victorian Minister for Health and the Premier for the work that they are doing in helping to support the federal government to reform that and improve that, because it is ridiculous that we have so little bulk billing in this community that people are going from service to service to find the one that they can afford. To have that record electronically helping them with their health management, helping medical professionals care for them, is vital, and I absolutely fully support this legislation because it is important and it is necessary. I commend the minister and her department for the work that they have done.
David SOUTHWICK (Caulfield) (11:21): I was elected to this Parliament in November 2010. On 8 May 2010, one day before Mother’s Day, my mother passed away. She passed away from a failure in the health system, and from that day forward every single day when I come into this chamber I think about those failures and how we can improve them, because we must. I know people from all sides of this Parliament are very focused on trying to do that. I note certainly the previous speaker was talking about the importance of actually fixing the system, and I absolutely agreed with that.
To be able to have health records that follow the patient, to be able to understand what issues the history of the patient may have, is absolutely crucial. The fact that we have more information on our cars when we take them for a service than we do on our mums and dads and family members is a disgrace. You think of so many things that we have advanced as a country, as a state, but when it comes to health it seems like we have not come that far at all. I think about that 2010 moment. It was not long after that that the Auditor-General did an investigation into HealthSMART, which was meant to bring all of the hospitals together and have information shared. It all became too hard, and the government of the day just turned around and said, ‘We’re not going to invest any more’, and a couple of hospitals just said, ‘Well, we’re not going to cooperate. We’ll just go alone.’
David SOUTHWICK: It is just completely absurd the fact that, as the member for Lowan said, $1 billion has been completely wasted and an opportunity has been lost, and we now are discussing some 13 years later how we go about fixing it.
I absolutely support the fact that we need to improve the health records. For that matter I will fight each and every day to ensure that people do not have the same situation that I went through. Without going into too much detail, my mother passed away from going from one hospital ward to another and not even having the information transferred from the emergency department to a ward. It was as basic as that. The previous member mentioned about faxes. Well, things were just filled out on a piece of paper, and again, that piece of paper did not transfer from the emergency department at the Alfred to a ward. It was a complete failure. My mother was left without oxygen, my mother was left without being monitored and my mother passed away as a result.
We need to fix it, and the proposal from the member for Lowan, which is a reasoned amendment, is a very important one. It is a fair one, it is a reasonable one, because what it does is it gives the rights and the responsibility to the patient to opt out if they want to opt out. I certainly would not be one of those that would opt out. I say that publicly now. I would certainly be one that would want to make sure that all that information is available for me and for any loved one, providing that that was their wish as well. But there are many exceptions to that, and there are many people who would want the ability to opt out. In fact if you look at this and you do not actually provide an opt-out, it actually provides potentially more harm than what the intention is in doing that.
We were having a discussion just before about drug and alcohol services. You look at the injecting room in Richmond – many people are using that injecting room. Each time they visit the injecting room that is going onto their record. Who might access those records? Do we want somebody to not access a health service because of the fear that that information could be recorded and used at a later time? We do not want that. We want people to use health services and access health services and drug and alcohol services if they have a problem and if they need help. That is why we need that opt-out.
The Law Institute of Victoria says that very eloquently. In fact LIV president Tania Wolff – I actually went to school with Tania’s brother Alex – has said a scheme that involves sharing patient data within the public health system must be on an opt-out basis similar to the federal My Health Record scheme. One in 10 Australians have opted out of the federal health record scheme according to the Australian Digital Health Agency. They have done it federally. It is an opt-out system, and you have got one in 10 who have opted out; still nine out of 10 are using it. Who knows, down the track, you might find more people want to take it up, but there has got to be confidence in the system and you have got to give people choice. That is what this is all about. That is what our reasoned amendment is about – it is about giving people choice.
Of course we want to be able to support the patient. Of course we want to be able to use the data to treat the patient in the best way possible. We have to do all of that. But at the end of the day, for a whole range of people and for a whole range of reasons, we need safeguards. This includes people having issues around mental health, family violence, sexual assault, sexual history, termination of pregnancy and drug and alcohol use. These are all areas where you need to be able to give the individual the option when it comes to sensitive information to opt out.
There are two negative consequences of not giving them the opt-out. Firstly, for those who might have had an experience or a trauma in their past, it takes the control away from them. We have spoken a lot about family violence and sexual assault issues in the Parliament. The last thing that you want is to take away the control of an individual by having them effectively having to report and having to have that recorded. There are so many laws where that is voluntary and where there is the ability for a person to have that power, and this should be one of them.
We have spoken a lot in terms of changes to laws when it comes to groups like the LGBTIQ+ community. There are instances where members of the LGBTIQ+ community having their information shared without consent may undermine their identity and open them up to discrimination. There are examples from a whole range of individuals where without their consent, without the ability to opt out, this would not provide confidence for those individuals to take part in the system. For the system to work, for people to have confidence in that system, we need to have that opt-out option. We need to give the option for people to opt out. I know others are talking about opting in and all kinds of things – that is not going to work. We have seen a model that has worked very effectively in the federal system. We should follow that in the state system. This is very sensible.
Quite often people talk in Parliament about oppositions being critical, and I say to the government today: we are not being critical. We are providing a better way of being able to do this, a better option that would create more confidence in this system if we provided that opt-out method. I would implore the government to take up this reasoned amendment moved by the member for Lowan. It is a sensible, reasonable amendment. What it does is it creates more confidence in the system and allows more people to use it and more people to get treated. It would fix our health system, which quite frankly needs to be fixed. We have got to ensure we have better digital records and we have better flow of information. This is an important way to do it. I am very happy that we are discussing this today. I think it is a long time overdue, but let us get it right. Let us not have to come back to this Parliament in six months or 12 months time with an ‘I told you so’ and then have to add an opt-out because we have got all kinds of issues and lawsuits and everything else from individuals that have taken the government to court because their information is being used against their will and without their knowledge. We do not want that situation. We want a system that people have confidence in, a system that everyone can get involved in. On that basis, I commend the member for Lowan’s reasonable reasoned amendment, and I ask the government to support the reasoned amendment.
Tim RICHARDSON (Mordialloc) (11:30): It is a real privilege to rise on this bill, the Health Legislation Amendment (Information Sharing) Bill 2023, and to talk about the importance this has for my local community and all Victorians. I want to address some of the issues that have been put forward in the reasoned amendment and also clarify some of the things that the member for Caulfield has put forward.
As a whole we have in our health system an aging population, pressures on our mental health and wellbeing system and elective surgery wait times that we are working so hard to address as a government, and there is pressure on our health workers and on our system like never before. The impacts of a one-in-100-year pandemic have been felt in every corner and every jurisdiction across Australia, and indeed in Victoria. So the ability to support and care for Victorians and have a more efficient and integrated health service and information sharing is a really critical feature. It makes sense to people that we would have that kind of approach and that care and that support.
There are a couple of things that are worth noting: there are currently no opt-out arrangements under existing legislation, and Victorian public health services share information for the purposes of treatment. The member for Caulfield talked of all these examples of lawsuits coming – the existing arrangements are in place now. Was the member for Caulfield alluding to things that are on foot in the County Court or the Magistrates Court or the Supreme Court now, or is this another example of some of the fear campaigning and discussion around opt-in arrangements that we saw so, so devastatingly put forward during the COVID-19 pandemic around vaccinations? I mean, I would not want to see that as a pathway that we take for arrangements that have been in place for many, many years – that there is to be an opt-out arrangement now. And the notion of all these lawyers and all these lawsuits coming – what on earth does that mean in the context of what is being put forward? The existing arrangements do not allow for an opt-out, and importantly, no other state has an opt-out system. So are the attorneys-general coming together in every state and territory? Would the Commonwealth now say that there is an avalanche of legal cases? I do not think so. So when you put forward a reasoned amendment and say that this is coming, let us think of where we are at the moment.
Let us also reflect on the debilitating issues and impacts of not having the information sharing. What is the greater good and the impact that is being felt by Victorians now? We know that this bill and this intervention will save lives, not for a lack of effort and a huge amount of sacrifice being put in by our health workers, our mental health workers and our clinicians across all of Victoria, who do an incredible job and have been pushed to the brink by the impacts of COVID and now some of the staffing challenges and shortages that we have at the moment. It is not through a lack of effort from our doctors and our health services across Victoria, but these are systemic challenges that are frustrated through bureaucratic channels and some antiquated systems. This is bringing this into the 21st century and making sure people are supported. But it goes further than that.
If you have got an issue about opt-out – and this should have been clarified in some of the contributions – there are the most stringent security controls on this platform, and there has not been a history of a breach with the department. So we go to that point again, and I reiterate it for the member for Lowan and the member for Caulfield: there has not been a breach in that setting. We have got the most stringent security controls, and then, if they bothered to read the second-reading speech, there will be a review within two years, so the accountability and the stringent protections are there to make sure that at all times we are thinking about the outcomes for and support of Victorians.
Bringing a reasoned amendment and delaying this legislation would impact again on the lives and outcomes of Victorians, who we are looking to support by making sure that administrative and bureaucratic impacts and health services do not risk lives. Do we delay that into inevitability? And then with those opt-outs, which are not in any other jurisdiction, state or territory, and the fact that we have not had that substantive breach there – what is the wrong that we are trying to correct here? What are we actually doing here? Or is this more about politics? Is this more about frustrating the bill and about frustrating the work of the house? I mean, that is the justification here.
When we cannot point to a breach, when we suggest that there is a mountain of legal challenges through the courts coming – even though the system is in place now and health services in their own jurisdictions support and share information and this is making it more effective for the future, a technological advancement rather than some of the antiquated systems we see – I am not quite clear on the approach and what they are actually trying to achieve here. But maybe those opposite in jumping on the bill will be able to allude to the avalanche of cases that are already before our jurisdictions at the moment. The proposed new structure is secure. It is sharing health information. It makes sense. We have seen it across other jurisdictions as well that establish that single point of complete and accurate patient information for clinicians.
If I take the example of mental health and wellbeing and the huge amount of work that is going into the Royal Commission into Victoria’s Mental Health System recommendations to support the mental health and wellbeing journey of Victorians, we see people go through various health settings. They might move around and be transient during that time as well, and their experiences of their treatment and their journeys were played out in the royal commission – those impacts – and sometimes the lack of information on that journey of a patient impacts on their wellbeing as well. We saw that in the thousands of people that came forward to share their lived experience. If we can make their outcomes better, if the information is not restarted every single time someone fronts up for support – if you change your postcode then you have to change all of that work and effort; you have already fronted up, you have already been retraumatised, you have already gone through all of that impact – if we are able to have a better setting and a better outcome for Victorians then that just makes sense.
Some things were alluded to by the member for Caulfield as a risk to data and information. People are already accessing prevention of family violence services now and getting that support – that safe, confidential support – from a range of different service providers. Some of the things that were alluded to that were glancing touches were really concerning, because there did not seem to be an evidentiary basis to what was being alluded to at all. It was a glancing reference to this big risk of this change, where we are already seeing a lot of that support and that peripheral support being provided now, and then there were just mentions of various policy areas or headline health and wellbeing areas as if they are going to be a source of risk going forward. That is a big concern, and there is form to that kind of language and that narrative that we saw during the 59th Parliament.
I ask members opposite: is this going down that pathway around government control and all that nasty narrative that we saw in the 59th Parliament, or is this an advancement in intellectual debate and raising the standards in this Parliament? Because if it is going down that fear campaign path – that government has got control of your information – we saw some of the grandstanding that occurred on that out on the steps of Parliament when some of those far-right elements, those people, were standing up there and championing that, and that went really well for them coming into the 60th Parliament! When we hear the Leader of the Opposition talk about raising standards, hopefully this is an intellectual discussion rather than the lowest common denominator that suggests that people’s records are all at risk when we have not had a breach, when there have not been those serious issues and when health services are sharing that information now and we have all those reviews in place.
This makes sense in a number of different areas and for people who might be experiencing chronic health issues across their journey and across their life as well. When we think of the huge complex bureaucracies that are dealing with aged care, the NDIS and mental health and wellbeing in health settings and in interactions with our GPs, this makes a lot of sense in a number of areas. I know my health services in the Mordialloc electorate have reflected that to us. Sometimes the inability to share that information is leading to poorer patient outcomes. We saw the change back in the 1990s with some of those health reforms of just the structures of health services and the ways that they operate. We need to do better, and that is an important outcome going forward as well.
I will just conclude on a couple of points in addition to that and just reiterate some of the data breach and safety controls and reiterate to the house that an independent oversight committee supported by a clinical advisory group will be established to provide that advice to the Secretary of the Department of Health, acknowledging that there have not been those breaches. That is important as well – there are safeguards on top that the minister outlined in her second-reading speech. These include establishing appropriate risk, control and compliance frameworks, and a primary management framework will be implemented prior to the commencement to limit access and provide for management of highly sensitive health information. It is what Victorians would expect. They would not expect this bill to be kicked down the road into the never-never, risking patient outcomes today. Let us get this done. Let us get it through the house, let us get it through the upper house and let us change the outcomes and support the health outcomes of Victorians and save lives. Let us not waste a moment based on the politics that we saw in the 59th Parliament.
Richard RIORDAN (Polwarth) (11:40): I find it vital that I respond to some of the comments made in the debate by the member for Mordialloc. As a big part of his contribution this morning he made reference to the fact that there is no evidence of data breaches and there is no foundation for any concerns that either the opposition or the community might have about an all-in system and the risk to patients. I refer him to – he should be aware of this because not only was he a member of the Public Accounts and Estimates Committee at the time, but I think he might have also had some assistant ministerial roles in health – May 2019, Barwon Health and the Auditor-General. I will quote quickly regarding the report from the Auditor-General:
In a scathing report, Auditor-General Andrew Greaves revealed his office had successfully accessed sensitive patient data at health services including Barwon Health …
and others on the South West Alliance of Rural Health (SWARH) network. With all due respect to Auditor-General Andrew Greaves, I am putting him in the category of probably not the world’s savviest hacker; if he could do it, probably any kid at school could do it. I am more worried about those organised crime gangs and others around the world that we have seen access Optus, Medibank and other large institutions that, I gather, would be far more sophisticated at protecting their data than the Victorian government. But our own Auditor-General pointed out very clearly you could drive a semitrailer through the security networks that this government has for its medical health records.
It is also important to understand that it has become evident in creating this legislation, as previous speakers on our side have pointed out, that there is the concept of having a readily accessible health record for all people across all our various health services and particularly for constituents in my electorate, a country electorate, where most people will journey through many hospitals and health services to meet their ultimate needs. You just do not easily access a major Melbourne hospital for a serious condition. You often go to your local GP and then to a regional health service. You often get moved on to Geelong and then on to Melbourne. That is a regular progression for many people in country areas, so it makes sense that those records can flow more easily with you.
However, what we also know in Victoria at the moment is that those various networks are completely fragmented. Going back to the example from the Auditor-General and the testing that they did on what is known as the SWARH system in south-west Victoria, including Geelong through to the border, for that health system most of the services were down for nearly six months. The government talk about, ‘We have to rush this through; we have to have it all in and not step back and give confidence in the community,’ and in so doing they have got to recall that in that six-month period in south-west Victoria surgeries were cancelled and vital healthcare and health records were locked and inaccessible to patients and to doctors. It is a real risk when this concept goes wrong, and there is no shortage of very, very critical examples.
We have seen the torment and heartache with, I think it was, the Medibank insurance customers who had sensitive medical data being sold to the highest bidder on the internet. These are real concerns. The key to the success of an all-in information sharing health service is the community having confidence in it and the community understanding that their details are safe and in good hands. This government has a real responsibility to be able to prove that, because the track record to date, despite some of the government’s contribution to the contrary, is not brilliant. People have a reasonable concern with that. Once people have a concern about the safety of their records, they are not going to seek the health care that they need. They are going to steer clear. They may go elsewhere to seek services, and that is not what we want in a modern, progressive society.
The opposition has presented a reasonable solution to this problem: a reasoned amendment that says we need to be able to allow people who are concerned about these issues to opt out. What is really important – and this bends a little bit to the example that Auditor-General Greaves raised about the security – is FOI. If you have sensitive information in a system, it is your information. You have a right to know who has been looking at it, who has been sharing it and what progress it has had, because unfortunately – once again drawing on some examples I know of in my community – health services are often, in smaller communities, the largest employer. Across the state as a whole they are a very, very large employer.
There are many thousands and thousands of people who will have access to the system, and currently we do not have a foolproof monitoring system for the information we have. For example, it is an unfortunate reality, but people can pry into the system and look. Health is one of those very sensitive information areas. We had a relatively recent example in my own electorate where the community knew very, very quickly about a particular person’s particular health concerns. I do not wish to elaborate in detail here because it would only, in Hansard, further exacerbate the problem, but the reality was that more people found out more quickly than the family and other members in a small community about a person’s particular health condition. Now, there is nothing in place that checks or monitors that, and in fact word of mouth, gossip and innuendo can travel more quickly around some communities than whatever the government’s monitoring system does. I found out when following through on this that there is not a system that will alert hospital administrators and other information minders to who has been accessing information. They might do spot audits. They might randomly audit particular individuals. For example, why would someone in a finance department be looking at pathology reports and other reports? But in the smaller regional areas they certainly have access to that type of information.
The government has a lot of work to do and a lot of convincing of the general population that they have the necessary regulations and processes in place. With the way the world is going at the moment in terms of the value of getting this information and corrupting it, there are many, many smarter minds than this government at work wishing to undermine and devalue the benefits that this type of computerised, centralised, data-sharing information can deliver to the population as a whole.
The opposition believes in the concept of what the government wants to do but believes it is more important to make sure that the community can have a maximum amount of confidence so that it continues to use our health services in an open, honest and frank way but can also protect itself ultimately. We strongly urge the government, government members and those in the upper house in a future debate to consider some minor changes that could make this a better piece of legislation.
The final concern that some members and certainly community members have is that the government does not have a strong track record in getting information sharing, computerisation and up-to-date mechanisms in place in our healthcare system. For example – we talked about it and made much of it during the COVID epidemic – we are still heavily reliant on faxes in some areas of health care. We have still got situations where data and patient records and information are not readily available across wards and at the coalface for many smaller health services in particular.
There is not a guarantee with funding and equipment updates and the basic mechanics of running a data sharing network that the funds and resources exist right across the state out into our smaller regional communities and even our larger regional health services to keep them up to date. We often hear of a complete lack of resourcing into these areas. As a country MP, as someone who has 10 public health facilities across his electorate, these are important issues, because we cannot on the one hand sell the benefits that we are going to make healthcare quicker and more responsive and safer for the community if at the end of the day we are only going to be guaranteeing those benefits to some people and particularly to those who live in larger metro areas rather than to the people of Victoria across the state, across all health services and across all provision of health.
I look forward to the debate continuing, and I look forward to perhaps for once the government being prepared to take on a positive suggestion from the opposition in a reasoned amendment.
Iwan WALTERS (Greenvale) (11:50): It is a privilege to rise to speak in support of the Health Legislation Amendment (Information Sharing) Bill and particularly to follow up the contribution of my friend the member for Mordialloc, who I think provided a marvellous exposition about why this bill is necessary but also debunked some of the more scurrilous suggestions about how the framework enabled by this bill could be used. I have listened very carefully to the debate this morning, and I am a bit confused about where members of the opposition really sit on this. The member for Lowan talked about her concern about the all-encompassing nature of the system that will be enabled by this bill but also wanted it to speak with GP systems. The member for Polwarth talked about his experience with a fragmented system, and I will also talk about my firsthand experience of that, where hospital systems do not speak to each other. Well, there is a good idea that this government has come up with to enable that, and it is enabled by this health information sharing legislation. The trust that the member talked about is undermined by scurrilous suggestions that there have been breaches of this exact type of system. I believe the Barwon Health breach was invoked. There has been no breach of a departmental system. This new system will have the strictest controls in order to prevent exactly that sort of thing and to learn from it.
I will discuss why this bill is not just an important reform to our health system. It will save lives and it will improve care. Of course it will improve information sharing across Victorian hospitals at the point of care and for the exclusive purpose of patient care. As I will turn to later on as well, the efficiency in care dividend that an integrated statewide system can deliver will be maximised if it is a light touch for clinicians and those who are using it, because of course the purpose of this bill is to support our wonderful clinicians working in Victorian hospitals to access important patient information to improve patient care and experiences, and vitally, while continuing to recognise patients’ rights to confidentiality and privacy. I would also go so far as to say that this bill also represents a significant micro-economic reform that will improve the efficiency of our hospital system. It will free up the time of clinicians to provide the wonderful care that they do rather than wasting their time on the phone and sending faxes which, as the member for Mordialloc and the member for Eltham mentioned, is an incredibly significant point of vulnerability in the system if we are talking about the protection of data. We may as well be using carrier pigeons. In this day and age to be reliant upon antiquated technology when safeguards can be built into technological-based systems to make sure that data is safe, secure and centrally available I find staggering.
I just want to touch briefly on why the bill is needed. Health care is integral to Victorians’ wellbeing and their quality of life. It is an important precondition for effective participation in society and the economy. Headline indicators of Australian health, whether it is life expectancy or preventable deaths before the age of 75, have improved enormously over the past 50 years, in large part because of reforms that Labor governments have implemented to Medicare, to the NDIS and to other forms of social security. But these indicators mask the growing prevalence of chronic disease and the underlying inequalities in health status among Australians. Chronic disease now accounts for 80 per cent of ill health, which does flow through to hospital presentations. Many patients attending Victorian hospitals will have been there before, often to receive treatment for the same or related conditions. Furthermore, most Victorian patients will visit more than one health service for health care and treatment. This is not just the case in regional and rural areas, as the member for South-West Coast would know, it also applies to members of the community in my constituency of Greenvale, who might be treated at the Royal Melbourne Hospital, then have follow-up treatment at Broadmeadows Hospital before subsequently presenting at the Northern Hospital. The availability of complete and accurate histories, diagnoses, pathology reports and other essential data saves lives and improves the quality of care.
There are real risks to the quality and safety of patient care when information is fragmented or missing across that journey. Under our present system patient health information is dispersed across a multitude of electronic medical records (EMRs) and even paper-based systems, none of which talk to each other. That fragmentation means that clinicians are often needlessly delayed by the need to manually gather patient information through those phone calls and faxes I talked about earlier.
I have had the privilege of moving around Victoria while accompanying and following my partner on her basic training and then advanced training as a doctor. I have had the privilege of living in wonderful parts of our state through that. Whether it has been in Sale or in Ballarat, I have often had to leave the room when she has been on call or responding to queries from the hospital, often in relation to incredibly sensitive acute cases of children with cancer or trauma or requiring urgent surgery, so that she can have extensive but fundamentally duplicative conversations about a patient’s history and other aspects of their care with treating clinicians at other hospitals. These are incredibly sensitive conversations. We talk about privacy and we talk about security of that data – if it were not for me leaving the room, I would be privy to those conversations. There are no safeguards to stop somebody else being a second-hand party to a conversation or seeing the paper that is sent across to different hospitals. I have seen the frustrations of doctors in regional centres who have acutely ill patients in their care and are left waiting on the phone to speak to specialists at other hospitals and waiting for that right person to be free or for faxes to be sent. It really is only one step up from the humble carrier pigeon for information to be sent and received, invariably after time-consuming searches for the correct paperwork. It is inconsistent with modern health information-sharing standards and the approach taken by other Australian jurisdictions.
Paul Edbrooke: Why don’t you like pigeons?
Iwan WALTERS: I do like pigeons; I take up the interjection from the member for Frankston. But while pigeons serve an important purpose, I do not think it is in the administration of a modern healthcare system.
We have heard a lot about the fragmented communication that exists between hospitals. EMRs, or electronic medical records, are already used to tremendous effect within hospitals. More than 60 per cent of public beds in the Victorian system are supported by them. They support clinicians to prescribe medicines, order tests, record patient histories, develop and document care plans and more broadly treat patients in their care. This bill just offers the opportunity to systematise those benefits. In that sense it is a real micro-economic reform. To strengthen our Victorian health system as a whole and to harness the transformative value of digital health, there needs to be an enabling environment that facilitates and encourages the acceptance of digital health technologies. That is exactly what this bill is doing: providing the clear legislative and regulatory framework that Victorian hospitals, clinicians and patients need and that Victorian health services have told the government and the minister that they need and want.
I have been speaking with a lot of clinicians myself since this bill was tabled, and to realise all of the benefits that the legislation could facilitate for Victorians it is important that end users, both clinicians and patients, are taken into account. I want to thank the minister and her team for their deep engagement and consultation across the sector and with members of this place in developing this bill. The full value of health information sharing will only be realised if all stakeholders in the health system, especially clinicians, buy in. We have seen in the past that if digital health tools are deployed in ways that do not take those end users into account, they do run the risk of being sidelined or abandoned. The previous federal government’s challenges with the My Health Record – a worthy vision which could have empowered patients and improved quality of care – highlight this. Digital solutions in health care work best, and I believe that this legislation will enable the creation of a system that does that: streamlines and automates hospitals’ workflows while removing redundancies. Time is of the essence when it comes to health, and a seamless, well-integrated health system will do just that, all while saving lives.
I am delighted that the information-sharing system that will be developed by the Department of Health as a consequence of this bill will be light touch for clinicians. Those clinicians who I have spoken with are delighted that this legislation is before the Parliament. All they have asked is that the EMRs that they deal with on a day-to-day basis speak with that platform to avoid the dual entry of data, to make sure it is light touch and to make sure it is easy for patients and their clinicians and their treating doctors to use. Again, I thank the minister and her team for their consultation. I think it is important to recognise that this will be a new system with strong, stringent safeguards built in to protect patients’ data and to ensure that this government can carry on saving lives and providing great care across Victoria.
Annabelle CLEELAND (Euroa) (12:00): I rise today to speak on the Health Legislation Amendment (Information Sharing) Bill 2023. Before getting too deep into the contents of the bill, I would like to take this opportunity to thank the amazing healthcare staff across my electorate and in fact the entire state. They do an incredible job, often under immense pressure in under-resourced environments. We have great local hospitals, from Kilmore, where I previously served as a community representative, to Seymour and Benalla. We also have Euroa Health, whose need for public funding I will continue to raise with the Minister for Health. Whether it be in a hospital, general practice, allied health or anything in between, everyone in our health system locally deserves a heartfelt thankyou for the work they have carried out through the pandemic and the work they continue to do every single day.
This bill is not one without controversy, but it is great to be able to speak on a bill that draws debate. As has already been mentioned, we will be seeking to amend this bill to provide an opt-out clause to Victorians – something in line with the standards set by My Health Record at a federal level. I do acknowledge the importance of streamlining communications and updating record keeping systems to provide better outcomes for Victorian patients. The main purpose of this bill is to amend the Health Services Act 1988 to establish a centralised electronic health information sharing system for participating health services to share certain health information, which consequently requires the authorisation to collect and disclose this information. The establishment of a centralised data-sharing system was a recommendation of the independent report commissioned by the government in 2015 following a series of seven avoidable baby deaths at Djerriwarrh Health Services at Bacchus Marsh hospital. My heart goes out to the families who continue to grieve the loss of these babies.
While I may be a relative newcomer in this chamber, the bill before us now is not. The original 2021 version of this bill lapsed in the last Parliament. The Law Institute of Victoria has again asked for this bill to be withdrawn, just like it did in 2021, for greater consultation to occur with industry over privacy concerns and the inability of patients to control their recorded medical history. The Law Institute of Victoria’s objections to proposed legislation are nothing new to this government in the health sector, and I hope those that are sitting in the crossbench in the other place in the 60th Parliament have a stronger commitment to the transparency and accountability.
The bill nonetheless does aim to achieve something our health system desperately needs, and that is better outcomes for patients. Our health system simply is not working the way it should, and nowhere is this being felt more acutely than in regional Victoria. This government came to power in 2014 with a Premier who said he would save the minutes that save lives across our 000 system. I think they are actually 3 minutes later than they were when we were last in government. The average ambulance in a code 1 emergency now arrives more than 3 minutes slower than it did when the Nationals were last in government – some facts.
I want to make it very clear: we are certainly not opposed to creating a more fair and equitable health system for Victorians, particularly not while more than 80,000 Victorians are waiting for elective surgery – and that is a number the AMA suggests is a gross underestimate. Not only that, we are seeing one-quarter of patients not receiving the surgery they need on time and 10 per cent of patients waiting for more than a year. In our health system we certainly do need to be using technology to our advantage. This is especially true when our emergency departments see patients on time at a rate below the national average. Greater use of technology is crucial to ensure we are being as efficient as possible with the paltry resources provided. Outside of South Australia, we have the lowest number of full-time equivalent healthcare staff and public hospital beds in the nation.
There are several areas of concern with the bill and a number of key provisions I would like to outline. The bill provides power to the Secretary of the Department of Health to specify in the Government Gazette that health information must be given to the secretary to establish the patient health information sharing system. In the explanatory memorandum the scope of the information to be specified could include information such as medicines, allergies, alerts, admissions, discharge summaries, outpatient consults and laboratory and imaging results. In addition to this, the secretary can direct health services to provide prescribed information and disclose specified patient health information for the purposes of the new system without requiring the consent of patients to whom the information relates. The bill also ensures that the collection of the patient data is continuous and ongoing and information must be provided within five days. Access to this electronic system will be provided to someone who is employed or engaged by a participating service and who is authorised by a health service to access the system, with penalties in place of up to two years imprisonment for unauthorised access to the system. Finally, the Freedom of Information Act 1982 does not apply to the electronic patient health system, with this decision stated as being due to the participating health service holding more detailed information and being the primary source for the specified health data.
As a newly elected MP, I have found the vast majority of constituents are not watching Parliament live or overly concerned by the inner workings of the house – instead they come here. However, on this bill I have received a much higher level of correspondence from the community than I would expect. Given the record this government has, its reputation for secrecy and sometimes questionable motives, I can certainly empathise with these concerns. There are some very genuine areas of concern with this bill, ones that have been identified by the Law Institute of Victoria and ones that have not been addressed by the latest instalment.
Like the previous bill, the sharing of patient information will not involve the consent or knowledge of patients, with no opt-out option available. While the aim of the bill is to strive to improve medical outcomes, this does need to be balanced with and give thought to patient autonomy. As we have heard earlier, one in 10 Australians opted out of My Health Record. There is no doubt a significant percentage of the population would prefer an opt-out option or believe in the concept of patient choice and autonomy. Given not all health services have to comply with these new regulations, it seems interesting patients do not have the option to opt out of sharing their personal information.
Concern around data security and safely storing deeply personal medical information is something we must take seriously. While there are penalties in place for unauthorised access to the system, I have concern over how these breaches will be identified and how we can design a system that is hack proof and secure to ensure information is kept in the hands of medical professionals who are authorised to access data to improve medical outcomes. As has also been raised earlier, there are some concerns around IT and cybersecurity. While there is a delay in the implementation of the bill to allow the department to put systems in place, I hope consideration is given to compatibility with interstate IT platforms. This is of particular concern in my electorate, where a significant percentage of residents in towns like Benalla access health care on both sides of the border. The lack of safeguards for the disclosure of sensitive information, such as mental health, family violence, sexual assault, sexual history, termination of pregnancy and drug use, is something that needs to be considered.
The exemption from the FOI act will place a large burden on existing health services. With no opt-out clause, it is only natural there will be an increase in individuals seeking to understand what level of information is being held by the government. Again, given this government’s passion for secrecy and the continual decline in the rate of documents released through FOIs under its watch, it is understandable the people of Victoria are sceptical about any move to make a data system that holds their personal information FOI-proof.
The Nationals support amending this bill and ensuring it is reworked to provide individuals with the ability to opt out of this centralised health-sharing system. This is the first bill I have had the honour of debating in this chamber, and the amendment we are moving is one that could not illustrate more clearly the respective values of the Labor Party and the National–Liberal parties. I have come to this place as someone determined to fight for my community. While I have the freedom of choice to disagree with my party on principle, those opposite do not. I believe in the values of choice and personal responsibility. Sadly, those opposite must follow the leader and put their communities behind the party’s wishes day after day.
I think Victorians should have the ability to have a choice when sharing their private health information, and I support amending this bill to provide that right. What I have stated above is why we have moved a reasoned amendment in this place on the basis the government should redraft the bill with an opt-out clause.
Juliana ADDISON (Wendouree) (12:10): It is my pleasure to join the debate today. I would like to compliment the member for Euroa on her first contribution. Out of respect for that I bit my tongue and there was no calling out. I know it was your first contribution. But I want to say that I share the values of the Labor Party. There is no need for me to ever worry about things because we have a strong, vibrant Labor Party where we debate issues and I am very, very happy where I am.
I am very, very happy to stand up and support this bill. It is the Health Legislation Amendment (Information Sharing) Bill 2023, which proposes legislative amendments to implement a secure information-sharing platform for Victorian health services. I am pleased to follow on from the outstanding member for Eltham, who shared the experience of her family with her father receiving excellent care in Gippsland, followed by the member for Mordialloc, who gave a really great contribution addressing the opt-out matters and why that is not something that we are prepared to entertain, that is not an amendment that we are prepared to look at, because this is what other states do. We will not be doing that, because we believe that adequate protections are in place. And how about the new member for Greenvale – what a superstar, what a rockstar. It is hard to believe that he has only been in this place for such a short time after such an outstanding contribution. As someone who, whilst representing metropolitan Melbourne, has had so much experience in regional and rural Victoria, you are a real asset to the Labor Party, so I am so pleased to have you here.
It is members like those that I have listed and others who hold our nurses, our paramedics, our hospital cleaners and our allied health workers in the highest regard. We support them day in, day out. Once again I offer my sincere thanks and gratitude to our healthcare workers for all they do for the Ballarat community. The Minister for Health has had a very, very busy less than 12 months in the job, and I thank her for again bringing this bill to the house. There is a mountain of work that the Minister for Health has done to support our healthcare workers, building new hospitals, investing in world-leading health infrastructure and providing safe and quality care for patients, and for me that is what is really important: safe and quality care for patients.
Prior to being elected to this place I was chair of quality and safety at Ballarat Health Services, and it is an issue that is very important to me. That is why I was very, very eager to speak on this bill. The Minister for Health understands the importance of sharing records, because like me she is a regional MP who cares deeply about her community, and she wants to make sure that regional communities and regional patients get the same care as our metropolitan brothers and sisters. That is what this bill will ensure.
I welcome the support that this government is giving Grampians Health, in particular for our Ballarat Base Hospital redevelopment – a record $541.8 million to redevelop the base. But we are also providing other infrastructure support, like $3.5 million for a replacement radiotherapy linear accelerator, a LINAC, to treat cancer patients and reduce the need for Ballarat patients to travel to Melbourne for treatment. Another way we are supporting Ballarat patients is the introduction of robot-assisted surgery. The new robot at Ballarat is amazing. I got to scrub into theatre just last Monday. It was incredible watching this surgery, being in there and just thinking: whether you are in London, whether you are in New York, whether you are in Boston, no-one in the world has got access to better robotic surgery than we do right here in Ballarat, and I could not be prouder as someone who has worked so hard to get that.
I also want to recognise the extensive efforts of the ministerial office and the Department of Health, who have developed this legislation in consultation with relevant stakeholders. This is something this government does very well. We go out and we talk about legislation and we consult. From clinicians to consumers to hospitals and health services, several relevant commissioners and legal bodies, unions – including the great leadership of Lisa Fitzpatrick at the ANMF, great people at the Australian Nursing and Midwifery Federation – and professional associations including the AMA are among those who have provided input. I welcome their contributions, and I thank the department for the extensive consultation that has been done to get this bill to this place.
The provision of quality health care is the cornerstone of our society. It impacts the mental and physical wellbeing not only of individuals but of entire populations. It also prevents the spread of infections and disease and promotes good health. We all know this to be the case, but our experience with COVID over the last few years has made it even more evident. In the ever-advancing field of medicine access to a patient’s medical information is crucial. Delays in accessing health data can be critical to determining treatment plans and patient safety, so it is so important that the right people have the right information at the right time to make the right clinical calls. If not, there could be adverse health outcomes, contributing to disabling injury or illness, lowering the quality of life or even leading to a premature death. Access to accurate and up-to-date health records can prevent adverse outcomes, and that is what we all want.
While Victoria’s public hospitals were split decades ago into separate networks, they are now more and more operating in concert as components of a single statewide system. However, this is yet to be extended to a standardised approach to sharing digital records. This needs to be addressed, as Victorians do not live their lives within the borders of a single health service. Indeed only this week as I drove to Parliament I went through various different health catchment areas. Victorians want to journey for work, for schooling, for family and friends and for recreation and sightseeing, and as a result if we find ourselves needing essential medical treatment, we may find it is some distance away from our home. For example, a Ballarat resident could be holidaying on the Surf Coast or at a Cats game at Kardinia Park or studying at Deakin’s Geelong Waterfront and they could be involved in an accident or suffer a serious health emergency. They would be rushed by ambulance to Barwon Health. Timely access to the Ballarat patient’s medical records from Grampians Health would be most beneficial for the treating clinicians and the patients to identify any medical procedures, medications administered, treatments received and adverse reactions or allergies to medicines. This is an example of why we need the Health Legislation Amendment (Information Sharing) Bill 2023. I do not want to see any patients suffering avoidable harm while they are receiving care in a Victorian health service, which could happen without timely access to health records – and I am pleased that the member for Geelong is happy about my Barwon reference and the Cats. Continuity of care is so important, and that is why it is at the heart of this legislation. We need to ensure that patients can receive, and professionals can practise, efficient and effective health care right throughout our state, which is dependent upon the availability of accurate, existing health information.
To this end, this bill proposes amendments to the Health Services Act 1998 as well as the Health Records Act 2001, which will build the legislative framework for an electronic patient health information sharing system to be used in a range of Victorian health services. This is a system that builds on the best practices of other jurisdictions, including New South Wales, Queensland, South Australia and the ACT, which have all implemented health information sharing at the point of care. Additionally, it reflects the very important Targeting Zero report – expert recommendations on the interchange of electronic information between hospitals. It has been mentioned but this important report, which was released in October 2016 after a review of hospital safety, focused on eliminating avoidable harm and strengthening the quality of care. This is the time for this bill, this is the time for patient safety, and I do not want to see it further delayed or stalled, like the opposition does. The bill proposes that the information sharing system will be established and maintained by the Department of Health and will provide in-scope services with essential summary information for the purposes of patient care. It is intended to include critical details such as allergies, medication, diagnoses, lab work and imaging results – information relating to a patient that is vital for ongoing care. Accessing the information can be crucial and time critical, but while health services can and do share information for the purposes of patient care, current communication methods have proven to be disjointed and cumbersome.
In closing, I would like to say that, as someone who has spent longer than any parent would want to in an ICU with their child in Melbourne, a long way from home, I support this bill, because regional Victorians when they bring their kids to metropolitan hospitals should be able to access their patient files.
Roma BRITNELL (South-West Coast) (12:20:320:): I rise to speak on the Health Legislation Amendment (Information Sharing) Bill 2023, but before I begin I would like to start by saying a big thankyou to all the health staff in South-West Coast. Across the seven health services within my electorate there has been an extraordinary challenge for the health staff with COVID over the last few years and also as a result of the fact that the health services are just not getting the funding they require to support the health staff. I would like to put on record my thanks for the hard work. They take their responsibilities so incredibly seriously and take very personally the health of our community, and for that I am very grateful.
That brings me to the purpose of this bill, which is to establish a centralised electronic patient information sharing service which enables services to access information about patients and their previous treatments, medications, allergies, admissions, discharge summaries, outpatient consultations, laboratory imaging results and the like. On face value this is a good idea – a very good idea. As a clinician in the past I would have given anything to have had access to someone’s information when they came in from a motor car accident and you needed to know details such as what their blood group is, rather than having to wait for a crossmatch et cetera. These are things that just make common sense, and this is something that we have been wanting for many, many years. In fact I was on the primary care partnership when they began back in I think the early 2000s. I was one of the first board members of the primary care partnership, or committee members or whatever it was then. It was set up to do exactly that – make sure that we could work out a way to stop patients having to tell their story over and over again.
Recently I met with a young girl by the name of Kristine Godfrey from Portland, who explained that she had a challenge with her child, who has a health issue. As a mum she found it extraordinary that she had to explain first to the speech therapist, then the paediatrician, then the occupational therapist and then the psychologist all the things that were going on – from one clinician to another. She said that as someone without a health background it just seemed extraordinary that it was her responsibility. What if she was not doing it well enough, not understanding the terminology? She is actually setting up her own application so that parents can communicate through this app with health professionals. But as a young girl with a young family, that should not be her responsibility. I wish her well on her venture, Carefully Planned, that she is developing. But these platforms should have been done within hospitals years ago.
However, whilst I agree with the sentiment of this, I have some very large concerns. The reason I have concerns is that this current government have been in power for 18 of the last 23 years, and they have got a long history of some really big stuff-ups, particularly when it comes to IT and managing data. Take out for a minute the privacy issues, which I will go to. Just the IT – this government have done a dreadful job, and there are examples. I will only have to bring up one to remind you about: the Victorian Registry of Births, Deaths and Marriages incident, where the IT system was implemented and six months later still people were not able to access death certificates. That period of losing a loved one and then getting on with closing bank accounts, paying bills or finalising the affairs is traumatic enough without not being able to do it because you cannot access a death certificate. There are many examples of this government having tried to improve IT systems fraught with dangers only to fail drastically.
Put that aside, but think about how the trust has been eroded with the community with those experiences, let alone this government in this bill not allowing an opt-out clause. As a human being in a free society, one of the things I think is really important is choice, and a government that takes away choice frightens me. What is their intention? Why do they need to take away people’s rights constantly to have choice?
Here is another example of it. In our MyGov system you have the right to opt out. Ten per cent of Australians have done that, and that is their right. But this Victorian Labor government are refusing to consider an opt-out clause, taking away your right to choose. I think that is reflective of how controlling this government is and how dictatorial they are and how they do not want the community to have the freedoms that we have always known in this state. To me that it is what this is symbolic of. And it is not just me that says this; I am hearing this right across the board, but particularly when we look at the consultation done by my colleague in the other place Georgie Crozier. There is a quote from the Law Institute of Victoria, from the information that they put out as a result of this legislation, which was stalled in the last Parliament because of these very same concerns – the issue that we cannot opt out but also that there is no provision for being able to FOI your own data. It will be in the department for people to look at, for people to do whatever they want with. We are not even sure what the parameters around that are. Here is the information from the law institute, who say that of the concerns they have with the bill, the most significant is there is no opt-out to the sharing of an individual’s health data and that the scheme is exempt from FOI requests.
Patient autonomy must be front of mind in any health legislation being put forward by government to protect patients’ rights.
It goes on, but it talks about how they are very concerned about thought not being given to the rights of a patient.
Anything that does increase efficiency in hospital I do endorse, but there is a reasoned amendment on the table here. It is a helpful reasoned amendment, it improves the bill and I think it would be remiss of the government not to endorse this reasoned amendment. I thank the local hospital once again, and I look at what South West Healthcare are going through at the moment with their hospital being way too small and the issues around emergency and the operating theatres. We finally got this government to agree to an upgrade in 2020. It is supposed to be completed by 2026 and ready for patients in 2027. I was really pleased to have an update from hospital. I thank the staff and the management and the nurses and doctors, who obviously I know fairly well, having been in the sector for so long in my electorate, for the updates they continue to give me. It looks like a really exciting development, but we are going out for tender soon, once the government have approved everything. I just urge the government to prioritise this build. We saw in 2018 this government promised funding for 10 hospitals which have not begun yet. Our hospital was approved for funding in 2020, so I am very nervous about that being completed within four years, given the heart hospital that opened in Clayton last week was five years overdue. Efficiency is what this bill is about, and efficiency is what we need in our hospitals. My absolute urge to the government is to please prioritise the building of South West Healthcare and do not let it languish like you are the health services that you promised in 2018.
I also think that efficiency within this bill is highly important, but it does not take over from listening to the community. If you listened in Portland, you would hear that they are desperate for services that are being removed. They are desperate for the support they need to keep the clinicians there, such as their ophthalmologist, such as their anaesthetist and such as their surgeons. Whilst it is really important to have the information technology system robust and talking to each health service – I get that – please listen to the community as well.
Labor have a poor track record of listening to our community. They have got less funding in Victoria per person than any other state for health. They have got less resources for staff than any other state for the health sector. This is not indicative of a state government that really does care about their health system, a health system that I think surely in the last three years has been highlighted as one of the very important assets in our community. Once again I would like to say thank you to the people of the seven health services and the ancillary services like the GP clinics that are not included in this legislation, which to me is another massive flaw, because if you do not start off your journey by including your GP clinics, then you have really missed an opportunity to improve the efficiencies.
We have got a Labor government in the federal sphere. There is a MyGov system. This could be improved. Let us go from where you start, with your GP, right through to wherever the health journey ends, and let us make sure this is done properly. This current bill is flawed.
Jackson TAYLOR (Bayswater) (12:30): It is a great pleasure to rise and speak in support of this fantastic piece of legislation in the house today, the Health Legislation Amendment (Information Sharing) Bill 2023. Can I start by acknowledging the Minister for Health and her team for the fantastic work they have done in putting together this bill and, importantly, the departmental staff who, as always, did a lot of the legwork and worked across not just their team but multiple teams in the department and across departments to bring this piece of legislation to the house today.
It is important that in the second sitting week of the year we are debating such critically important legislation that goes to, I suppose, the heart of this government’s commitment – in its third term now, the Andrews Labor government – to ensuring we are always improving the healthcare system, making it easier for healthcare providers, for our hospitals in the public system, to treat patients as seamlessly and easily as possible, giving them efficient and timely care as well, which in many critical situations in our healthcare settings are worth every single minute.
It is fantastic to be debating this legislation and speaking in support of it and acknowledging some of the previous speakers on our side. The member for Mordialloc – it is always an eloquent contribution from the member for Mordialloc – talked about the importance of this legislation to his community and pointed out some of the important values as to why this legislation is absolutely needed, particularly in the 21st century. It would seem odd to many that we have not yet done this, and of course other speakers have discussed in this place today how other states have implemented very similar legislation – in fact, almost identical – and now obviously Victoria is getting on with it.
To the member for Greenvale, it was noted that it was his first contribution in this place – and I tell you, that was one impressive contribution. It is very difficult to follow. Even though you were a good 20 or 30 minutes back, I still feel the pressure of your contribution bearing down on me. It was absolutely incredible to hear about your partner and some of the personal experiences you have had with this and your understanding of what this legislation will do not just for your partner but for other healthcare providers and clinicians.
The DEPUTY SPEAKER: Through the Chair.
Jackson TAYLOR: Of course, Deputy Speaker. It was wonderful to hear, so well done again to the member for Greenvale.
To the member for Wendouree, who always enters this place with such passion and gusto, some would say, and always gets in a few – not a few, quite a lot of – Ballarat references as well when we hear from her, I hope that when she scrubbed in for theatre she scrubbed straight back out, because that would have been a worry. I would not want to be in that theatre room.
Jackson TAYLOR: Certainly not if you were doing the actual work. Just briefly, at the table is the Minister for Tourism, Sport and Major Events and Minister for Creative Industries. I was having a chat to the good minister about some of the discussions that he and I have had with our constituents over the past week or two about the importance of this legislation.
Jackson TAYLOR: Sorry?
Steve Dimopoulos: That’s right.
Jackson TAYLOR: It was not even a good interjection – just ‘That’s right’. We were talking about some of the important conversations we have had with constituents in our respective electorates over the last couple of weeks who have approached us about this legislation.
As I have said right from the outset of my contribution, this is another way in which the Andrews Labor government is showing its commitment to health care. It is always seeking to improve it and is obviously getting on with providing the very best healthcare system in this country. I am so incredibly thankful, and it is at this point that I want to again acknowledge that I am very proud of the work of our healthcare workers and our staff in our healthcare settings across the state and, from my perspective, locally. They do an incredible job day in and day out. They continue to turn up and give people the care they need when they need it.
Talking about some of the important investments that this government makes, not just in the form of this legislation but in reforming the healthcare system to make it more efficient and make patient care even better, it is important to acknowledge that in last year’s budget we saw a $12 billion boost to health care in Victoria. Of course since even more recently we know it is now free to study nursing and midwifery. I know the member for Frankston is extremely passionate about this reform. I do not think a day goes by where I do not see it mentioned on his social media, whether in a comment or a post. It just goes to show how incredibly important it is, and that is one of the many ways we are helping to recruit and train healthcare staff into our system to make sure that care is there for patients when they need it. We know that that means we are going to be helping to recruit and train some 24,000 nurses and midwives. We know across the state the $12 billion investment will provide for better hospitals, more paramedics – over 400 extra last year on the road – and better care of course wherever you are. We will be delivering from that $12 billion the 7000 more health care workers, of which 5000 are nurses, and nearly 400 extra 000 call takers.
We know that this investment is not a new thing. Labor has always backed in health every single step of the way while of course we know that others will cut at every opportunity. We know that since coming to government we have recruited hundreds more paramedics, more than 22,000 healthcare workers and 8500 more who joined the workforce during the pandemic. The Labor government and our healthcare heroes are continuing to respond to the issues that are associated with the COVID pandemic. Just to mention briefly the $12 billion investment and what that will deliver, some of the work that is absolutely well and truly underway is $1.5 billion in a COVID catch-up plan to increase elective surgery beyond prepandemic levels, new hospitals, more mental health nurses, more support for emergency departments to meet growing demand and more support for women’s health, safety and wellbeing.
All in all since coming to government the Andrews Labor government have invested over $160 billion into our healthcare system. That is a profound investment – an investment that each and every single member on this side of the chamber should be proud of, and hopefully those opposite are proud too. It is a good investment. We should always be seeking to improve our healthcare system and invest every single dollar we can to make sure that patients get the best care and the staff are well and truly supported.
This legislation is another step forward to ensuring that providers can provide the best care armed with the necessary info in a timely manner. The legislation before the house today will enable the Department of Health to establish and maintain an electronic health information sharing platform – well canvassed by members in this place today. It will enable in-scope health services to access information about previous treatment received by Victorian patients from other public hospitals and in-scope health services for the purposes of providing effective treatment to patients in their care. It will amend the Health Services Act 1988 to require in-scope health services to disclose health information to the secretary for the purpose of the department establishing and maintaining an electronic health information sharing platform, and it will ensure the availability of up-to-date and accurate health information at the point of care to save lives and enable clinicians to provide the best care and treatment for patients in the Victorian public health system.
Improving these provisions for sharing information is critical to improving patient safety and continuity of care for Victorians. It is important legislation here in this house, an important investment by the Andrews Labor government over the last eight and a bit years, importantly not just in training and recruiting but in some of the profound local investments out my way in terms of infrastructure. I am sure, Deputy Speaker, there would be some in your community. I know you grew up in my patch out in Ferntree Gully. At the Angliss we are starting major construction this year – $112 million. That is going to create over 300 construction jobs at the height of construction. Early works are underway now, and that is going to provide more beds, more capacity, so people can be seen quicker and have the best care possible. We have just delivered a new public aged care facility in Wantirna – 120 beds. This is what aged care should look like everywhere. Those of you who have not had an opportunity and who are passionate about this space should come down to Wantirna and go and look at the Wantirna public aged care facility. It is absolutely phenomenal. Each room is decked out with an ensuite and a beautiful open space. That is the kind of investment we need to continue to see in aged care, and of course this government made further commitments at the last election to upgrade even more aged care facilities.
We are also getting on and we are committed to and we are absolutely going to deliver a rebuild of the Maroondah Hospital, the new Queen Elizabeth II – rebuild it from the ground up – up to $1.05 billion. It is going to be an absolutely fantastic facility. The Minister for Creative Industries has so many portfolios, I never know which one to address him by. It is going to be an incredible facility. Those local investments again show the kinds of investments we are making. Many members have spoken about some of their personal experiences, and we have probably all had a personal experience in the health setting, but just in a police setting in the times I was supporting people who needed care, as a police officer, in their time of need with critical mental health – acute mental health – issues, we were often calling around from place to place trying to find out information. This is going to help alleviate that issue. It is going to help people right across the sector. It is going to help our emergency services, and it will provide patients with even better care in the state of Victoria.
Bill TILLEY (Benambra) (12:40): I rise to make a brief contribution, or a pointed contribution, on the Health Legislation Amendment (Information Sharing) Bill 2023. Now, we know that last week there was an eleventh-hour briefing on what was to be no doubt – and we are hearing in this house – an aspirational bill seeking to do a lot of things. But while government members stand in their places and make a contribution from their talk sheets on what to say, for those with lived experiences in the country, particularly across border communities and right along the border of New South Wales and Victoria – every health service that is in category 1 which has obligations when and if this bill achieves royal assent and then becomes legislation – it is the consequential impacts that are going to occur on country and rural Victorians.
There were a lot of questions in that briefing, and I thank the minister for providing the briefing to the coalition, but I came back and looked at my notes after the briefing and saw this big, red ‘N-O’ on the middle of the page with all these spokes offshooting. What it did not answer, significantly: there is no idea of the total cost of this program, no chance for Victorians to opt out, no indication of the additional workload that this will create and particularly no clear idea of how this will work with cross-border communities. In addition to that, as legislators, the trade that we are in, there should not be a bill anywhere before the responsible minister has considered the consequential impacts or the collateral damage of bringing legislation into the Victorian Parliament and how it will affect country, rural and particularly cross-border communities. Every time you have brought a bill in here there has been an effect that really hurts cross-border communities. So, you know, I certainly think that is worth delivering in policy.
Bill TILLEY: And you can laugh along as much as you like. You are in Geelong, you know, but Jesus Christ. Anyway, moving on.
Chris Couzens: You can’t answer the question.
Bill TILLEY: I didn’t hear your question. I will pull the chain if I want to hear your question. Anyway, there is no way an individual can find out who has accessed their health data, even under FOI. There is no dollar figure on this. We do not know what it is going to cost. And why not? The minister in her second-reading speech spoke about the similar rollouts in New South Wales, Queensland, the ACT and South Australia. There is a simple answer. What did they cost? They have cost a bloody motza. It is not like this is anything new here. There is nothing new in this. You have had a good crack at the bill in previous parliaments. This is now, as we know, 2.0. We are having another go at this again and the unanswered questions still remain. With an implementation date of February next year, it seems totally implausible to me and many of the people in my electorate that you could plan a major rollout without a budget. I mean, give us something. Throw us a bone. Give us some sort of an idea of what is going on.
Now let us talk a little bit about consent particularly, and I will quote the exploratory memorandum:
New section 134ZL enables the participating health services and the Secretary to collect, use or disclose specified patient health information … without the need to first obtain consent from the patients to whom the information relates.
You know, if that is not clear enough, you cannot just ignore these important issues with this legislation that as professional legislators we need to consider. The old saying is ‘The proverbial flows downhill’. It is the consequential impact on the front line: the effect on our community, the effect on our doctors, nurses and all our clinicians. This is very clunky. As I said, it is aspirational, but you have got a lot more work to do on it.
We saw when the federal government brought in My Health Record that about 10 per cent of Victorians chose to opt out. If you say that quickly, it sounds all right, but in real terms that is 700,000 people.
A member: It is a lot of people, Bill.
Bill TILLEY: It is a hell of a lot of people that chose to opt out. It is certainly their right to opt out. When this goes through, heaven help me, this will be scaring the pants off people. I get the intent to improve health care, and that is important, but get it right.
Having health providers on the same page is fine. I do not want to make too much of my most recent visit, but I will give you a practical experience. Albury Wodonga Health has two campuses, one in Wodonga, one in Albury. The service plan is changing where acute services are going over the border to New South Wales. I can present myself at the ED in Wodonga, and then they say, ‘No, no, we’ve got to step that up and send you across the river into New South Wales.’ They have been trying to do this for eight years now and have not achieved it. They will not have a clue, if they put me in a meat truck – sorry, an ambulance – and send me over the border for urgent treatment, they will have no idea who I am, and vice versa. They have been trying to achieve this for many, many years, so good luck with this if you want to bring it into Victoria.
We have seen since December last year significant security breaches, with FRV, Medibank, our revenue office and the federal police all being hacked. There is no certainty or guarantee that you can buy your way to someone that is going to deliver the datasets and the information and be able to guarantee absolutely beyond any reasonable doubt that you can protect people’s privacy or their clinical information. I understand and get that they are justifiably worried about their information.
As I said, cross-border – it is the only area in the nation – there are certainly some plans and some ongoing negotiations, and I hope that, with the local governments of Wodonga and Albury and surrounds, the government comes to the table and continues to make much better options for the clinical needs of our communities. We need more beds. Look at Ballarat – they have got 700 beds. We have only got about 300 beds but we are the same size. We have more output than Geelong does. We have more response across the two borders, but the problem is that the bureaucracy of New South Wales and the bureaucracy of Victoria – the health bureaucracies – do not necessarily talk too well to each other. Heaven help if you want to turn around and bring this legislation in when you have the bureaucracies in the relevant jurisdictions. How in the hell are you going to do that within the state as well, because the nation is getting smaller and people are going to travel and there is this implementation with cross-border and all that sort of stuff. Heaven help if you want to travel and get crook interstate. That is not the intent of this bill, but as the nation gets smaller, we need to step it up and make sure that we have the best clinical outcomes for not only Victorians but Australians right throughout the country.
I get exactly what the bill is trying to circumvent. I get all of that, and the boffins, but you have not been able to do that. You have got a long history. You have got a rap sheet of a whole lot of failures in IT and other things. You have got to own this stuff. The thing is to do it with both sides of this house. We want to sit down and work with you, but no-one has a monopoly on the good ideas. And you can sit there and laugh with your shit-eating grin and all of that sort of stuff –
The DEPUTY SPEAKER: Order! Unparliamentary language!
Bill TILLEY: Mate, it does not cop it with me. We have got to be the grown-ups in the room, all of us, all right, and get this bloody right.
If you are transferred from Albury Wodonga Health, you will not be sent to St Vincent’s or Royal North Shore in Sydney. If you are a New South Wales resident attending Albury Wodonga Health, you are likely to be sent to the Alfred or the Royal Children’s or Monash or somewhere like that. There is no indication whatsoever in the facts or history that the contraindication with all of this is that it is just simply going to have an adverse effect on all of those things.
I could bump my gums for a bit longer and go on, but please listen to cross-border communities – listen to rural Victoria. We need better. You need to do better and address them, and no bill should come before the house unless the responsible minister, the minister of the Crown, has had a look at the consequential impacts of what it does to cross-border communities and regional and rural Victoria.
Paul EDBROOKE (Frankston) (12:50): Do not get me wrong, I love Mr Tilley getting up and bumping his gums, as he says. But I am going to speak on this bill, which is the Health Legislation Amendment (Information Sharing) Bill 2023. From the outset I would just like to make clear that I appreciate our health workers – our doctors, our nurses, our cleaners and our cooks – for everything they have done in a really, really difficult period, a very difficult period, for this state and this nation and also internationally. Can I also thank the Australian Nursing and Midwifery Federation. We are in the early stages of building a new hospital for those doctors and nurses that are part of that union. We have bought Frankston Private Hospital, or acquired Frankston Private Hospital, and it is now doing elective surgeries for people all over the south-east. I think we are up to 1500 elective surgeries, and that is a former private hospital now set up specifically to carry out elective surgeries to have an impact on that waiting list.
I would like to from the outset address some of the things I have heard while I have been sitting here in this chamber. The first and most egregious issue I have is members opposite talking about an alleged breach of information and data in the Victorian Registry of Births, Deaths and Marriages. Apparently someone has read that online – it might have been on Telegram, who knows – but I am not aware of any such breach. I would welcome anyone to come to this house with some evidence, because that is what we should be using to make our decisions – a foundation of evidence.
That takes me to the next issue I have got. We heard from those opposite that there was no consultation – or there was little consultation, to be fair. Well, the department conducted targeted consultation from October to December 2020, and I am sure it has been ongoing outside those dates as well. That was with hospitals and health services; the health complaints commissioner; the mental health complaints commissioner; the disability services commissioner; the Law Institute of Victoria, including elder law; and Victoria Legal Aid. And we have heard a little bit about what the Victorian Law Institute’s opinion is. I welcome different opinions on our legislation because it makes legislation better, but it does not always mean that we can side with everyone’s opinion when we are creating legislation for Victorians. The department also conducted consultations with clinicians and consumer representatives; professional associations and colleges, including the Australian Medical Association and the Australian Nursing and Midwifery Federation; other representative bodies, such as the Victorian Healthcare Association and the Australasian Institute of Digital Health; and also the Office of the Victorian Information Commissioner. Further engagement will be ongoing with some of these stakeholders, and it is natural that they will have sometimes pointed opinions about where legislation should land. We do take into account the opinions of those stakeholders.
We heard a little bit about the Albury-Wodonga issue, which we have heard about in this house before. I would just like to clarify that there is actually a funding agreement in place to consolidate both campuses at Albury Wodonga Health. This will provide efficiency between both campuses. I think with respect to the healthcare workers, with respect to the people that work in those hospitals and with respect to the people that work in our department, we really should be sticking to that foundation of evidence that I have spoken about.
This bill also has been, I guess like many bills, taken to a controversial place by those opposite. That really is their job – they are in opposition; that is what they do. Whether they do it well I will leave to you. But it is wrong to say there has been little consultation, and it is wrong to say that there has been no consultation or that there was a breach in the births, deaths and marriages database. It is wrong also to ask, ‘Why do GPs have no access to this system?’ The answer is pretty easy. It is because GPs use My Health Record, and they will have access to this database as well. My Health Record really contains summary information on patients. However, it is not designed to be a comprehensive record of information relevant to a patient’s day-to-day care in a hospital. The health sharing information system will complement My Health Record, and GPs will continue using My Health Record. I think that makes absolute, total sense.
We also heard from the member for Benambra about patients’ FOI rights. If I heard that correctly – I apologise if I did not hear it correctly – the allegation was that patients cannot FOI their own health data, and that is just plain wrong. This bill does not change a patient’s right to access their full medical records from their health service provider under FOI and privacy legislation. You can access and order records to see who saw your medical records as well. I mean, we hear about those in opposition going to briefings – maybe they should listen at the briefings or maybe they should ask more questions. There are some very, very smart people as advisers in our department that can actually answer those questions if those asking the questions are willing to listen.
I am not one to pretend that this is a simple problem – information sharing and data sharing has had its problems over the last decade at least – but comparing what we are talking about here to opting out of MyGov health is incongruent. What happened with MyGov health was a public confidence issue based around – whether they be facts or allegations, I am not sure whether they were proven – information being sold to Telstra based on databases; I think one was the cervical cancer database. Immediately over a million people decided that they did not want to be part of that database – and all power to them. You need, when you create these databases, to have public confidence.
For those opposite who still want us to be letting carrier pigeons with little notes on their legs carry our health information, I would just set the scene for what is happening right now. I had surgery last year, and I was glad that my records could be shared electronically. We are in an age where if you are concerned about information sharing you would be naive, because most people are on their phones, most people have signed up to apps, most people use e-scripts or telehealth – these are all electronic methods of communication that have risks, but you have got to mitigate those risks, and they have been done very well. People are on social media also. There are risks involved with that, but if you mitigate those risks the public have confidence.
But right now what is happening is if I go to a specialist and I have busted my leg, they might receive from a radiographer a fax of an X-ray. Now, that fax comes over onto a machine – and those opposite might laugh, but this is the case in some specialist offices. That fax will end up on that machine, and anyone – anyone, any number of people – can access that data, that information on someone. I ask those opposite: what is more risky – that or someone actually having an email or a database that they are the recipient of, something that is addressed to them that only they can access and their access is recorded and they can instantaneously get that information to help patients and save lives? What is more risky? What is more risk adverse? I would say if you think it is the fax, well, good luck to you. But certainly when I was in surgery not so long ago I was very happy – very happy – to have my details shared electronically, and I know this will take us into the future. I am sure there are some stakeholders that believe that they still can use their Nokia 3510, but we are not in there. We have got to embrace the future.
I would say too that COVID has pushed us into the future a long way. Everybody uses Teams. Everybody uses all the other platforms, and there is risk with that as well. There is risk with that, and there is risk with any data sharing, but it is about mitigating that, and the department have shown in those briefings and in the legislation that we can mitigate that risk. It is not comparable to anything federally based, and I definitely have the confidence in this to help people, especially in accidents, where information is timely and minutes count. I commend this bill to the house.
Sitting suspended 1:00 pm until 2:02 pm.
Business interrupted under sessional orders.