Wednesday, 22 February 2023
Health Legislation Amendment (Information Sharing) Bill 2023
Health Legislation Amendment (Information Sharing) Bill 2023
Tim READ (Brunswick) (14:43): I start by asking members to wonder: how could you know whether a pathology test result from 2022 might influence a treatment decision in, say, 2026? It is hard to predict our medical future. What you know about your medical past may be largely irrelevant to your medical future or it could make an enormous difference, and patients cannot know what information from their medical past will be critical to their medical future.
Victoria’s public hospitals were divided years ago into autonomous networks – I think it was in the early 1990s – but are now operating as parts of a single system. Especially during COVID, patients were being shunted from hospital to hospital. Patients from Sunshine were hospitalised in Geelong. But their digital records are not normally shared. Patients are often transferred between hospitals during an illness and their medical record then goes with them. But if a patient from my electorate is normally cared for at the Royal Melbourne Hospital but that is full and they wind up at St Vincent’s just a few minutes walk away, their medical record from the Royal Melbourne Hospital is out of reach and at 3 am vital information may have to wait until the morning. Patients actually in my experience generally assume public hospital doctors already have access to the information from elsewhere in the public system, and they are surprised when we explain that we do not.
In fact, to their credit, several groups of hospitals are already sharing their digital records, and that is because of them being part of the same network. The Royal Children’s, the Royal Women’s, the Royal Melbourne and the Victorian Comprehensive Cancer Centre network, all in Parkville, all use a single digital record system, so a comma written in one hospital can be corrected or complained about in another hospital. That is as it should be, because there is often swift movement of patients between those four hospitals. The Alfred, Caulfield and Sandringham all use a single system. There is a statewide public mental health record system. So where those systems are shared, patients can be moved and doctors and nursing staff can look back at test results that were mundane and unimportant two years ago but have suddenly become critical: is that little spot on the chest X-ray old or new?
Patients often cared for at one hospital just assume that all of that information has followed them somehow when in fact it has not, and it requires phone calls, delays and sometimes faxes or emails to get that information across. The information is vital in many ways. Medications may interact. There are drug allergies. There are alerts on records, such as severe asthma. There are unusual alerts that you might not imagine – for example, this patient is prone to violent behaviour when sedated. I have seen these sorts of alerts. These things are not things that patients necessarily remember or would know to communicate. Past biopsy results – biopsies can be painful and expensive and difficult to interpret; diagnoses that took months to make – not all medical problems are solved in the first 15 minutes, and some diagnoses take a long time; results of tests and scans, some of them very expensive scans: all of this information sits in digital medical records.
With this bill we can make this information immediately available to clinicians who are working under pressure. Or we can make those doctors or nurses wait on the phone or next to a fax machine; we can make them work with one hand tied behind their back. Allowing hospitals caring for the same patient to share information will reduce the amount of time clinicians waste on the phone trying to find it, it will reduce the incidence of dangerous drug interactions or allergic reactions, it will reduce dangerous misdiagnoses and consequent delays in appropriate treatment and it will reduce the repetition of painful, risky or expensive tests. Wasted time, needless expense and delays in diagnosis are common consequences of a lack of information sharing, and at a time when we are trying to help our public health system cope with COVID, we should do all we can to help. We have all of us in this place heard from outpatients who have been waiting unreasonably long times for outpatient appointments, for scans and especially for surgery. Less commonly, deaths can even result from inadequate information, and this bill comes out of an investigation into the deaths of babies in Bacchus Marsh some years ago.
The Greens support the intent of this bill to enable public health services to run more efficiently, to reduce delays and to make care safer by reducing the risk of harmful medical errors, which can occasionally be catastrophic. However, there is always the risk that the wrong person may find and misuse sensitive health information. That risk already exists for the digital and paper records used in hospital networks, and there are already layers of deterrents in place, including a strong institutional and professional culture to respect patient confidentiality and the fear of dismissal and legal action. However, more could be done to reduce the risk of inappropriate access and disclosure, and this bill is an opportunity to discuss and strengthen this.
Patients who opt out of the whole system would be at risk of any of the above consequences when usually all they might want is to prevent their ex-husband who works at hospital A from seeing their positive chlamydia test or a reference to their past abortion or their drug-induced psychosis that they had years ago in hospital B. But they are perfectly happy for their chest MRI scan and their blood biochemistry to be accessible to the public health system. So rather than opting out of the whole system, we should consider whether it could be feasible for patients to nominate either certain facts or information to be omitted from being uploaded to the shared platform or for their record to not be available at their request to the wider group of health agencies listed in the legislation and only to public hospitals where they are current inpatients.
We should look at whether further limits should be placed in this legislation on the secretary’s powers to disclose information to other agencies, such as the police – other agencies, that is, that are not involved in directly caring for the patient. We would be interested to see a mechanism for patients to learn what agencies have accessed their information. I gather that the FOI exemption in this bill was intended to reassure Victorians that the Department of Health is not looking at or involved with their data, but that does not seem in the current environment to have been effective reassurance and so this exemption should be reconsidered. They can as it stands get their data from the hospitals. An FOI is costly and time consuming, so some mechanism for improving access other than by FOI would be welcome.
The Greens look forward to working with other parties in the Legislative Council to see what reassurances and improvements we can collectively achieve for this bill. That is why we will not support the reasoned amendment in the lower house, which is a rather blunt instrument, while we are willing to consider some aspects of it. So let us pass the bill this week to help our stressed public health system and take the opportunity to improve the bill in the other place and strengthen health privacy while we are at it.
Steve McGHIE (Melton) (14:51): I rise today to contribute to the Health Legislation Amendment (Information Sharing) Bill 2023. Firstly, I would like to acknowledge the work of the Minister for Health on this matter and her hardworking staff, especially with our pandemic response taking priority and unfortunately delaying these amendments. I would also like to acknowledge the member for Brunswick’s contribution and of course his clear explanation as a doctor in experiencing the sharing of medical information between facilities and what it means to the patient care outcome of many, many patients. As he alluded to, not all patients relay their medical history or remember their medical history or remember the drugs that they take and things like that. In some cases they are not even in a situation where they can actually relay any information to the medicos –they could be in an unconscious state – so it is important. This bill is clearly about patient care and better patient outcomes, and I thank the member for Brunswick for his explanation. As I say, as a doctor he has been through those experiences before, where the information could have assisted him in dealing with his patients on different occasions. I appreciate what he has contributed.
I am also very proud to be part of the Victorian government, who continue to improve patient safety and provide continuity of care for all Victorians, making sure that our health clinicians and practitioners have at their fingertips the tools that they need when they need them. Again, we have had it raised in this chamber that patients can be moved from facility to facility subject to the circumstance of their situation, and it is important that medical information is forwarded and shared between those facilities so the receiving hospitals can, firstly, be prepared to be able to treat that patient, and secondly, be able to deliver the best possible patient care and outcomes.
Continuing to deliver on our election promises and the trust which the Melton electorate has given me, this is an issue that in my previous life as a paramedic I saw firsthand – the benefit that this proposed amendment to the health legislation will deliver. Ambulance Victoria have had their own electronic and digital system for many, many years. It is called VACIS, which is the Victorian Ambulance Clinical Information System, and it has been in place, as I say, for many years. This is an electronic patient care record The purpose of introducing that system for the ambulance service was for paramedics to put in as many details and other details in regard to the situation of the patients that they are treating and transporting to hospital and to be able to send that information off to the hospital before they arrive so the hospital has some knowledge and are able to look up a patient’s history if that patient has been at that hospital previously. That system has worked very, very well. There have been modifications to it for the ambulance service on a number of occasions to try and improve it, but it has worked very well. I dare say it is something that is still in place. I know that the hospitals receiving that information are grateful to receive good, thorough electronic information prior to ambulances arriving, and it is important for patient outcomes.
In an emergency, when every minute counts, access to accurate and vital health records saves lives. It is obvious that patient electronic medical records, the EMRs, bring hospitals and health services into the 21st century, driving healthcare advances and improved treatment outcomes for patients around the state. I am excited that the new Melton hospital, when it opens its doors, is going to have access to this system. As well as having a 24-hour emergency department, it will have at least 274 beds. It will have an intensive care unit. It will have a maternity unit and a neonatal unit. It will have mental health services, radiology services, ambulatory care and, as I said before, mental health beds. It will be a full tertiary hospital. We hear a lot of background noise from people that are naysayers about this particular hospital. These are big infrastructure builds; they take time to build. I am pleased to say it will occur and building will start at the start of next year and be completed towards the end of 2028, early 29. And it will be a great asset for the western suburbs – not just Melton but the western suburbs – and it completes that corridor: western Footscray, western Sunshine, Joan Kirner hospital, western Melton, the Bacchus Marsh facility, and we also have a Melton medical facility right now that will be complemented by the new hospital. So for people to say that the western suburbs are being left behind – I do not know what planet they are living on. It is certainly not the same planet that I am living on, that is for sure. When the Melton hospital is operational, it will have the capacity to treat 130,000 patients each year, and it will also see 60,000 patients go through that emergency department. We are talking about the sharing of medical records, and we are talking about 60,000 patients – a lot of those patients that will go through that emergency department will already have a medical history at other facilities, and that will be shared now with the new Melton hospital when it is open so those patients can be treated with up-to-date information through the sharing of that information.
It is nigh on impossible to find a Victorian who has not visited more than one health service for care and treatment as a patient. Currently, as it exists, our personal health information exists in multiple silos across multiple health services, and this bill will improve on that situation by getting rid of the silos and being able to share that information right across the networks. Most Victorians will often be treated at different health services over their lifetimes, and patients cannot know what information from their medical past will be critical to their medical future. Of course, depending on the circumstances, patients may not be able to provide all or accurate medical history, and as I said before, there can be circumstances that lead to that, subject to the incident that the patient is involved in, whether it is a medical condition, whether it is an emergency situation, whether it is a traumatic situation, whether it is a drug overdose, whether it be a serious assault or things like that. You do not always get the relevant information from your patients. As I said, as a paramedic it is important to try and do provisional diagnosis and treat people, but to try to get all the information – it is not always forthcoming. I am sure you have all been through this when you have been to your doctor – do you tell your doctor everything that is going on? I do not think so. You tell them enough – what you feel you want to tell them – but you do not tell them everything. You do that for certain reasons, and that is an issue. Of course the medicos can only treat based on the information they gather and what is before them in regard to signs and symptoms and the information that the patients provide. So it is important to have a good medical history, it is important to share the information, and that will lead to better outcomes. But again, we all think that we are all honest when we go to the medicos and tell them everything about us, and we do not. We do that for various reasons. Some of it could be embarrassing for us. And I can tell you I have done that at my doctor’s: ‘No, I don’t drink alcohol. I never drink alcohol’ – and obviously people in this chamber would refute that. But my doctor thinks I am squeaky-clean, so that is great.
Over the last 20 years health and medicine have undergone a digital revolution, and as I alluded to before, the ambulance service introduced their VACIS system many, many years ago, and it has been such a success. Again, we have proved why Victoria is one of the most respected biomedical research precincts in the world, with cutting-edge research and discoveries, training some of the country’s brightest minds as well as adding strong economic value to Victoria. All of this medical information sharing will lead to better outcomes, because as I say, I know with the VACIS system in ambulances they collect a lot of data in regard to prehospital care.
I know the minister is at the table. It has been important data in regard to the types of incidents that they respond to, the types of treatments, the drugs that they may use and the numbers of resources that they might respond to a certain incident with. The way we deal with drug overdoses now is quite different to what happened in the 1970s, 80s and 90s. There is quite a different response, and the medications that they have are quite different in dealing with these patients. That sharing of information is really important.
As I say, if we can get a broad system right across the networks, right across the state, rather than be siloed into health networks in just the east or the south or the west, if we can broaden out right across the state with that sharing of information with the ambulance service and with other health agencies, then it can only lead to much better outcomes for patients. As I have said previously, this bill is about patient care. It is about better patient outcomes. It is about having enough information for the medicos to be able to treat people better. I commend this bill to the house, and I thank the minister for it.
Jade BENHAM (Mildura) (15:01): The Victorian health system in this state, we know, is in quite a state of disrepair, so any more we can do to help our frontline healthcare workers has got to be a positive, right? This bill in its concept initially is good, but it does have flaws. The simple answer is yes, obviously we want to help our frontline workers, but this bill is not that simple. The base concept of this bill would be great. Our healthcare workers – our ambos, our allied health professionals, our clinicians – would love to be able to get hold of all sorts of patient information in a snap, and that was pointed out by the member for South-West Coast earlier today. In my electorate of 35,500 square kilometres we have five different health services. They include Mildura Base Public Hospital, East Wimmera Health Service, Mallee Track Health and Community Service and Robinvale District Health Services, and they are supported a great deal by the Royal Flying Doctor Service.
In fact the Royal Flying Doctor Service are about to increase their service delivery to the Robinvale district. They held a round table there last week, which I attended, and it was fantastic. The robust discussion and debate and ideas to come out of an event like that were truly inspiring. It is a testament to what can actually occur when you bring everyone to the table with the freedom to tell the truth and work through some of the issues that we know occur, where the gaps are and how they can be filled and give people the freedom to speak freely. It is an exciting time, and I do congratulate Robinvale District Health Services; Dr Jane Neyland, our beloved doctor; and the Royal Flying Doctor Service on their collaboration efforts so far. We are truly very lucky in Robinvale. This is thinking outside of the box in terms of rural health care, and we need much more of it.
What we do not need is putting everyone inside the same box. This bill would help to streamline processes across rural health services, and I am sure having all of the multipurpose services and subregional health services able to share information would be very effective if an accident occurred on Ouyen Lake or on the Murray River, for example. I would like to offer my sincere condolences to the family and friends of the young man who was the victim of a fatal accident last weekend on the Murray River. It is something no-one ever wants to see occur obviously. It is an absolute tragedy, and my sincere and heartfelt condolences do go to his family and friends that were there with him at the time. Also, thank you to those first responders, the police divers and emergency workers who responded to this tragedy over the weekend. You do the work of angels, and words will never be enough, but thank you for your service.
Now is the busy harvest period. Safety standards exist and are better than they used to be, although there is still some work to do there as well – farm accidents are always possible, and they do occur, because most of the work is still done by humans. But if an accident occurred on a farm during harvest and the worker was from the city – actually, that probably does not happen, but you know what I mean. If they are coming in from other parts of the state, access to information from other health services would be very helpful. But what happens when these patients are from interstate, which for us is literally 2 minutes away? The border in border communities is used more for recreation than it is for separation; we operate as one. Unfortunately that river does create two states, which is something that the member for Benambra pointed out earlier today. Will this database talk to the Far West Local Health District in New South Wales like we would need it to in the Mildura electorate? No, it will not. It is only mandated for some specific health services like the ones I have mentioned – the multipurpose services and the subregional health services – but not GPs. Wouldn’t that also be very, very helpful? It is a decent concept, but these are the flaws that do not make sense. These are flaws and they are actually horrendous. If we are going to do this, we need to do it once and we need to do it well.
Over the last three years people of this state have been forced into things they did not wish to be; it is a fact. They are sick of it; it is a fact. People in my community who were locked down and mandated by the government are sick of being told what to do and being told that they do not have a choice, which is why we need an opt-out clause. This is fact, and I know this because I do in fact spend a lot of time talking to my community. In the last week I have done almost 2000 kilometres in the car talking to members of my community. I have received emails and phone calls to my office raising concerns about the lack of substantive amendments made to this bill since it lapsed in the last term of government. These are everyday people with a past who are not comfortable with the fact that this scheme is exempt from freedom of information requests. They are concerned that they cannot opt out. They are concerned that their medical past might come back to haunt them even though it might be well and truly in the past. It is a very real concern.
As the member for Lowan spoke about earlier today, those who may have been victims of sexual assault or may have been hospitalised for mental health issues et cetera in the past and sought treatment probably do not wish for their records to be available to someone in a health service who has been delegated to have access. If you have sought treatment for mental health, family planning or any of those things spoken about by the member for Lowan, you would like that to be protected. This is a valid concern for all of us, and we need to give Victorians back their freedom of choice. For some it is fine; there is no concern. The sharing of medical information in a government database is nothing for them to be concerned about, and that is fine, but there needs to be choice. There might not be anything sketchy in there – great – half your luck if you have got nothing sketchy in your past. It is not that way for all of us.
Jade BENHAM: Yes. A very medical term, thank you, member for Gippsland South.
There is also the threat of cybersecurity breaches, which we have seen. Health databases are a target. We have seen it with Medibank. We have seen it with all sorts of cybersecurity. Cybersecurity is one of those things that does personally scare me – it is a major concern – and for others it is the principle and the fact that they are just sick and tired of being told what to do and of the government overreach.
Going back to the hackers, health information, like I said, is something they target. If you get health records with Medicare numbers and all of that in there – current addresses – that is enough to steal your identity. You only need to hack one database and you have got enough to steal the identity of hundreds of thousands or millions of people. We need the choice to opt out. Until we can get an absolute guarantee, which we cannot at the moment – no database can guarantee 100 per cent safety, particularly one that has not even been budgeted for – we need to do this properly. It could cost hundreds of millions of dollars, which could build a brand new Mildura hospital that could replace the one we have outgrown and that we so desperately need. Granted, we do not know how much that will cost because we are still waiting on the master plan. There is still work to be done here. There is a lot of work to still be done here, and the best place to start is giving Victorians their choice to opt out, not to be mandated in, and for it to be included in FOI requests. That may not create perfection, but it is a good place to start and a way for us to all work together and be constructive on something that actually could be very good here. Whilst the concept of this bill I agree is good, it is not perfect. The inability to consider each clause in detail means that it is not as good as it could be. Until the government agrees to listen to all Victorians and allow it to be debated clause by clause it will not be as good as it could be. I will say it again: if we are going to do this, we should do it once and do it well.
Michaela SETTLE (Eureka) (15:10): I rise to speak on the Health Legislation Amendment (Information Sharing) Bill 2023. Look, I am very pleased to stand to speak on this bill. It is obviously a very important bill. One of the things I really admire on this side of the house is that we have people with real lived experience, so you get opinions and you get people that really understand the issues. Of course I would say that of my good friend, who has now left the chamber, the member for Melton. It was fantastic to hear his contribution because he is someone who has worked at the coalface and really understands the importance of that information and having that immediately. To a lesser degree, as the mother of two boys I have done my fair share of visits to the emergency department, and I know how important it is, how time-critical things basically are, when you are in an emergency situation.
Before I go any further I really want to acknowledge healthcare workers across Victoria. This government has really stood with our healthcare workers and all those people engaged in the healthcare system. I think it is really clear and has always been very clear that they understand the support this government has given them. It was very, very clear in the election period at any sort of medical announcement which side of the house had healthcare workers standing with them, because they know that we are there, we have their back, and indeed leading up to the election they had ours.
This bill is an incredibly important one. It is about bringing our health system up to date. It is something that already goes on, the sharing of information, and it has to, but it goes on in archaic forms. It is funny that we talk about the fax machine. I can remember the fax machine coming in way back in the 1980s, and it is certainly an old piece of technology now. That information sharing is happening now, but it is happening using old transmission routes, if you like. One of the things throughout this debate that I have sort of battled with listening to the other side is that their arguments around this bill seem to be pretty higgledy-piggledy. On the one hand they completely support the notion of shared information, but then there is this idea around security of that information. What I find interesting when I listen to that is really it is just them continuing to denigrate our fantastic health workers. You know, there is some suggestion over there that people are going to illegally access information and documentation. Let us be clear about this: they are talking about people who have committed to professional standards already. They are suggesting that those people are going to throw aside all of that professionalism and suddenly start sharing and leaking information. So, as I say yet again, those on the other side do nothing but denigrate the fine, fine workers of the healthcare system.
There also is this sort of bizarre argument here around it not going far enough, that we should be including GPs, we should be including across the border – but we should not be doing it at all. So it is the flip-flop that we are absolutely used to from those on the other side. I do not know whether the member for Euroa wants us to share with New South Wales or not share with New South Wales. On the one hand you are telling us that we should not be putting this system in place at all and in fact should be making all steps to hold it back. The member for Euroa suggested that this was something around the way our government operates. What I would say is that perhaps the member for Euroa does not understand the notion of consensus.
Danny O’Brien: Mildura.
Michaela SETTLE: No, I am talking about the member for Euroa – yes, earlier – who suggested that we were forced to make these decisions on this side of the house.
Indeed what we do on this side of the house is come to a consensus and work together, and I do understand that the member for Euroa is fairly new and coming to terms with what is an absolutely frayed coalition on the other side. I mean, that they can even call themselves a coalition at this stage is pretty interesting. But look, really, around this bill, I think the idea that patients will not have FOI-able rights is just rubbish; all of the FOI that you normally have, all of those rights, will stay and remain.
There is a lot of security that will go around this. We are absolutely committed to protecting patient data. I think there was a great contribution from the member for Mordialloc, who talked about the fearmongering from the other side, as usual, when they talk about some tsunami of court cases that are going to come from having this system in place. As the member for Mordialloc quite rightly pointed out, this already exists in jurisdictions across Australia – in New South Wales, South Australia, ACT – and we have not seen a tsunami of breaches and a tsunami of court cases. But of course it just sits with the kind of modus operandi of those on the other side, who will just scaremonger to get political advantage. It is a great shame that they have so little respect for the people of Victoria that they would do that. We also hear these sorts of suggestions about the information and not having a choice. The fact of the matter is that information is shared now. The member for South-West Coast made some line about this being this government taking away choice. We are not taking away any choice. At the moment sharing exists. All that this bill hopes to do is to systemise, to make that easier, to make it quicker, to the advantage of all Victorians that are in need. So there is no taking away of rights. There is no change here. That sharing of information exists right now.
I think that most Victorians would be very, very happy to know that this government continues to try and improve the health system at every turn. We have the most extraordinary Minister for Health, and she and all of her staff work daily to find ways to improve the system. This is another one of those ways. Information sharing is absolutely fundamental. Information sharing exists now. But let us make sure that we share that information in the most efficient way, using modern technology. Those on the other side are known as conservatives; perhaps they would rather see us continue with facsimile technology. They do not like to see progress in any form or fashion, and I can only assume that is why they are objecting to this bill, because as we have said, the sharing of information already exists, so what we are talking about here is just upgrading the system. But they are blocking it. They are blocking it, because this is what they eternally do, because basically they have got no idea about progress. They do not want to see any progress. I cannot make this clearer – I do not know which bit they do not understand: this system already exists. It already exists. Your information right now can be shared. It already exists.
There is some notion that we are taking away some civil right, and I might add that there is no opt-out clause in any of the jurisdictions anywhere else where this is conducted. But as I say, quite extraordinarily, the fact of the matter is that this exists now. We are trying to make it better, more efficient. We are trying to stand by health workers instead of denigrating them by suggesting that they cannot be trusted with people’s information. Denigrating health workers – that is all those on the other side have ever done, and you can see that. What happened in the election? How many healthcare workers stood with people on that side of the house? Zero. I never saw a photo with a healthcare worker standing with the opposition, because they know who has got their backs, and it is people on this side of the house that have got their backs. I commend this bill because it is another sign of the Andrews Labor government supporting health.
Josh BULL (Sunbury) (15:20): I am always pleased to contribute to debate, particularly on this very important piece of legislation, and to follow on from the outstanding member and her contribution. She is someone who knows and understands her local community, somebody who for the last four years, in serving her first term in this house, always stood up for healthcare workers. She has always been a champion of her local community when it comes to health and is a fantastic member in this house.
As I said, I am delighted to have the opportunity this afternoon to contribute to the Health Legislation Amendment (Information Sharing) Bill 2023. Both as a local member and as a former Parliamentary Secretary for Health I have had the opportunity to work incredibly closely with our healthcare workers, which the former member touched on, but also I have had the privilege and the pleasure of working with healthcare workers right across the state – in the city, in the suburbs, in the regions, across the country. This government knows and understands the importance of the contribution, the hard work and the sacrifice of each and every one of those healthcare workers.
In my contribution this afternoon I do want to get to the specifics of why this particular piece of legislation is so important for our healthcare system and our healthcare workers and of course patients within the healthcare system. What we know is that all of our healthcare workers work incredibly hard each and every day to service the needs of our community. We know that health within this state was turned on its head in January 2020. We know, during the course of the pandemic, what our healthcare workers had to endure: the sacrifice, the commitment, the incredible workload and the incredible demand that was placed on our healthcare workers after COVID arrived on our shores, as I said, in January 2020. We know and understand the immense pressure and the extraordinary job that was done in saving lives, in helping keep people safe and in supporting our entire state. What we know is that this Andrews Labor government is a government that will continue to take our responsibility to work with our healthcare workforce incredibly seriously. We know that it is our role, it is our responsibility, to ensure that we make the job of our healthcare workers just that bit easier, because in doing that not only are we supporting that workforce, but we get better patient outcomes.
Acting Speaker, you know within your local community, I know as a local member and all members in this house should know and understand the value and the service and the sacrifice of our healthcare workforce, and this bill is all about ensuring that both those workers and, critically, the patients that they treat each and every day are supported. This is a bill about sharing information, about building a better system and about creating a stronger and more dynamic system for all Victorians.
We know that this government is a government that is committed to improving safety and continuity of care for Victorians. That also means ensuring our health services and clinicians have the appropriate tools and information at their disposal. We know that the proposed new secure healthcare system sharing platform will lead to establishing a single point of complete and accurate patient information for clinicians to provide safe and timely care. We know also that Victoria’s public hospitals were divided through the 1990s to have separate – fragmented if you like – operating systems that, simply put, just did not communicate with each other.
I have heard some great contributions from other members of the house during the debate. I think it may have been the member for Eltham who spoke about the fax machine and many of the outdated systems that are in place for information sharing. You do not find too many people throughout the course of your travels, Acting Speaker, and our travels through our local communities as local members, that do not have access to smartphones and do not have various devices at home – laptops, iPads, a whole range of different communication tools – that are used throughout our daily lives.
So the question really is about using technology for those purposes: using technology to ensure that we are sharing information across platforms and we are using that technology to the best of its ability to enhance the job – the incredible job – of our healthcare workforce. Therefore, putting patients at the centre of this is critical. We know that most Victorian patients will often be treated at different health services over their lifetime. We know that patients can move from community to community and what information is shared at that point is critical. We know that currently in Victoria our critical health information is spread across multiple services, as I have said, and this fragmentation of patient health information means that clinicians are often needlessly delayed by having to manually gather patient information, as I mentioned, through faxes or phone calls, and this can be of particular risk.
I was not going to go here, but I do just want to tell a short story of a very close friend of mine who had cerebral palsy. He was treated for many years at the Royal Children’s Hospital, and he needed at one point in time to be moved to another hospital. The challenges and the stress and the strain on both him and his family when it came to information sharing and the complexity of his particular circumstance placed enormous pressure on him and his family, and tragically he is not with us anymore. But what we know is that the system in that instance was a system that just was not up to scratch. It was a system that just did not support him. That takes us back to the fundamental principle about patient care, about patient support, about making sure that this government, the Andrews Labor government, introduces legislation, initiatives and projects that are at the forefront of using technology but also, most importantly, provide care and value and compassion and support. They are the things that we need to be embedding within legislation. We need to be supporting both the Department of Health – our senior officials, our bureaucratic agencies – and of course our healthcare workforce. Knowing that there is an opportunity to improve the outcome – that friend of mine and his experience and that of his family – knowing that there are better methods, that there is a way through this is fundamentally important and one of the reasons why this government is introducing this legislation today.
The access to health information platform changes will apply to specific entities. Those include public hospitals, multipurpose services, denominational hospitals, metropolitan hospitals, prescribed health services, registered community health centres, the ambulance service, the Victorian Institute of Forensic Mental Health and the Victorian Collaborative Centre for Mental Health and Wellbeing. We know, and others have mentioned in their fine contributions this afternoon, that many other jurisdictions across our great country have systems and legislative initiatives that are in place to provide many of the provisions that we are speaking about today. In New South Wales the scheme was implemented to establish a secure and statewide clinical portal which shares summary-level patient and clinical information across health services. The Queensland government have implemented The Viewer, which collates data from multiple Queensland health systems, enabling healthcare professionals to access patients’ information quickly without having to log on to different systems. There are other provisions within other states.
We know that when it comes to supporting healthcare workers within this state and when it comes to supporting patients, this government has a strong and proud record of doing exactly that. I stood in this exact place through the course of the pandemic, as other members of this house did, and we saw an undermining in many instances of our incredible healthcare workforce. We saw a scare campaign. Frankly, the people of Victoria had an opportunity to go to the ballot box and make their decision, their view, clear, and that is exactly what they did in returning this government for another term.
This bill strengthens our healthcare system. It supports the needs of patients. It supports the needs of their families. This bill is about caring for Victorians and about caring for families. We are a government that stands for best practice and a government that stands for science and stands for the best in patient care – for supporting nurses, for supporting ambos and for supporting every single patient to get the best of that care. That is why members of this team, through the Minister for Health, the Premier, the Treasurer, the entire front bench and all members on this side of the house, know and understand the importance of this piece of legislation. That is why I am very proud to have the opportunity to contribute to debate today and very proud to commend the bill to the house.
Chris COUZENS (Geelong) (15:30): I am pleased to rise to contribute to the Health Legislation Amendment (Information Sharing) Bill 2023. Can I begin by thanking the minister for all her hard work – and her team – to have this bill before the house. It really is a government priority to continue to improve our health system, bring it into the modern age and move it away from old systems that are inadequate and do not work. We need our healthcare providers to have access to good tools, things that work. It is really important. This information sharing already exists now, and we have had some great contributions from this side of the house. The other side of the house seem to have missed the point that we already share information. It is already there, but it is being shared in inadequate systems, by phones and fax machines, as we have heard from this side of the house. We want to improve that system as we want to improve all our systems in Victoria.
Victoria has one of the best health systems in the world. We have been challenged by COVID; there is no doubt about that.
A member interjected.
Chris COUZENS: Well, look at other parts of the world and then tell me what the difference is. There is a huge difference in places like Victoria. We are providing an outstanding health system, and our healthcare providers and all the staff and the backup people – our paramedics, nurses, doctors, everyone, particularly over the last couple of years – deserve to be congratulated for what they have done.
We have identified where we need to improve things, and this is a government that acts on that. I personally think that this is a fantastic bill around modernising that information sharing for the very reason that during COVID my father started in a community hospital, was transferred to a regional hospital, was then transferred to a major hospital in Melbourne, then back again to the regional hospital and back again to the community hospital. The communication by phone was a horrendous situation, with faxes coming through that had dirty great red lines through them. It was such an archaic system. We are now going to have a system that is improved, a digital system that is going to ensure that that information that is shared will be accurate and safe information that will be given to those medical practitioners that are looking after people – like my father at the time. I am sure there are many people in the community who can tell very similar stories, and we have heard that today on this side of the house from members who have had those experiences and are fully supporting this bill because they know it needs to happen.
As I mentioned, this government is about improving our systems. We identify and acknowledge and accept when something goes wrong and we make those changes. We commit to our community of Victoria that we are going to make the changes needed. In my electorate I know people will support this bill. I note the comments from the member for Brunswick when he said that people already assume that medical practitioners have their information in front of them on their computer. We know that that is not the case. We know that we have to improve the system. I have not had anyone come to me and say that they are not happy with this legislation or this bill. They are saying they support it because they can see the importance of it. They have had experiences like I had, where there are constant phone calls. I did not at the time know my father’s medical details that he had with his GP. I knew he had medical conditions, but I did not know what medication he was taking. By the time he got to the Melbourne hospital he was already not conscious, and they were ringing me in the middle of the night saying, ‘What medications is your dad on? What are his conditions, because we can’t get hold of his GP to send through the fax?’ I mean, we do not need a system like that. What we need to do is improve the system as best we can to ensure that those medical practitioners are getting the information that they need.
We identify what needs to change and we work on it as a government, and we see that in communities like mine. The health infrastructure funding that has been put into Geelong has been extraordinary. We are now starting the construction of the new women’s and children’s hospital, because we heard from my community the need for that. We heard from the experts, we heard from the paediatricians that we need this. As the population grows, there is more demand. Families have to go to Melbourne, to the Royal Children’s Hospital –
Sam Groth: For maternity.
Chris COUZENS: that is absolute rubbish – to get their children treated by the fantastic people at the Royal Children’s. They will not have to do that once this hospital is completed. They will be able to do that in Geelong. So I think there are great services that we offer in our regional communities, and we are identifying those and creating them, building them. The early parenting centre in Geelong – my community had indicated for a long time that they needed that. It is now under construction, about halfway through construction actually, and it will not be long before it is completed, which is really exciting for my community. It is exciting for I know the member for the Lara’s community, for the member for Bellarine and for the member for South Barwon. All the Geelong region communities will be able to use those facilities, even as far as Barwon south-west. These are really important infrastructure projects that were identified by our community, and we will be able to deliver those along with things like improving that health information, and that is important when we have new facilities like that – the women’s and children’s hospital, the early parenting centre, the drug and alcohol community hub which is about to open in Geelong, the acute mental health beds that we have just opened and the youth mental health beds that are going to open.
We need to ensure that we are doing what we can to ensure that those services are provided in our community, but we also need to be mindful that there are multicultural communities, people with disabilities and Aboriginal communities that rely on their practitioner or whoever is treating them at the time to know what is best for them. If they do not have the information in front of them, how do they do that without having to get on a phone and wait for hours to get results – you know, faxes that have dirty great red lines through them or are barely readable? These are the issues that need to be addressed, and we are addressing them through this piece of legislation that is before us today.
We heard about the heart hospital. The Premier talked about that in question time today. That is another significant opportunity for the Victorian community. This is about identifying what our community needs and delivering that, and I know my community in Geelong are very excited about the fact that there is now a specialised heart hospital in Melbourne that will be particularly addressing research around women’s heart health, which we have not seen. Again, that is about identifying an issue and dealing with it, and that is exactly what this government has done. For my community to have access to that specialised heart hospital is huge, because we have a cardiac unit at Geelong which does an absolutely incredible job – and I know that from my partner’s three heart attacks that he has had. The dedication that that cardiac ward provides is extraordinary. So again, it is about, yes, knowing and acknowledging when there are issues – and we have been challenged by COVID, there is no doubt about that. But what this government has done is it has not said, ‘Oh, no, there’s not a problem, there’s nothing to deal with.’ We have actually got on and made a difference in our community.
So I support this legislation. I think it is really significant for communities like mine and I am sure every other community across Victoria. It is about bringing us into the modern age. It is about digitising that information rather than having to rely on lots of phone calls and lots of faxes. We know it is happening in New South Wales and other states across this country. There is no reason why we should not be doing it. I commend the bill to the house.
Will FOWLES (Ringwood) (15:40): Thank you very much, Acting Speaker Hamer. It is nice to see you in the chair. It is my absolute pleasure to be speaking on the Health Legislation Amendment (Information Sharing) Bill 2023. In fact any opportunity we get as members on this side of the chamber to talk about Labor’s record investment in our health system is welcomed with open arms. I was particularly pleased over the course of the recent state election to make a commitment in my electorate, for my community, of $1.05 billion to rebuild the Maroondah Hospital from the ground up. It is a very, very large commitment, it is a very important commitment and it is going to make a real difference to the lived experience with the health system in my electorate of Ringwood.
Of course that is not the only investment we have been making. We are about to bring online that urgent care treatment option in Box Hill – in your electorate, Acting Speaker. Urgent care is available around the clock for the things that might not need the full lights-and-sirens response. Broken bones, wounds that are not about to cause you to lose consciousness or anything – those sorts of things can be dealt with without the lights and sirens. This will keep people out of the emergency departments, because what we have seen over the course of the pandemic is a set of structural challenges that have made it really, really difficult to keep EDs functioning at maximum efficiency. Those structural challenges have come about on both the demand side and the supply side. On the supply side we have had many staff furloughed because of COVID or possible COVID infections or family members being infected, and that has made it extremely difficult to staff EDs to their optimum levels. That is a challenge that we are experiencing right across the system, and not just in Victoria, despite the protestations of some in this place. Those challenges are being experienced in New South Wales and elsewhere across Australia and indeed right around the globe.
In the context of those challenges, what we have also seen is a bit of behavioural change that relates to seeking GP treatment and seeking it early enough to make sure that your health issues are addressed without needing to present to an ED. We are seeing some ED presentations – because public EDs do not charge – for relatively minor matters, which is putting enormous strain on the system. We are also seeing people presenting at an ED with matters that may well have been addressed had they seen a GP or another health professional earlier in the life of whatever ailment it is that they are presenting with. What we are seeing now is a concerted effort on behalf of the Premier and other state premiers to work with the federal government – because we have got a partner in Canberra now – to make sure that we have –
Danny O’Brien: On a point of order, Acting Speaker, I have given the member a lot of leeway. He has been speaking for 3 minutes now and has not mentioned the title of the bill, let alone referred to it, at all. Speaking on a bill on health legislation amendment is not just an opportunity for the member to talk about health in general. He needs to come back to the bill.
The ACTING SPEAKER (Paul Hamer): The debate has been wideranging, and the member was coming to the bill.
Will FOWLES: Thank you –
Danny O’Brien: Oh, he was!
Will FOWLES: Of course I was, and I did mention it right in my very opening comment. If the member for Gippsland South was not listening, that is entirely a matter for him.
The point I was making about system-wide challenges – the important bit here that gets me to the specific provisions of this bill – is that when you have got these system-wide challenges it is important that as a government you respond to those system-wide challenges by making sure you do everything in your power to make it easier for health professionals to do their jobs, to make it easier for GPs and other clinicians to get the information they need to help the diagnostic process, to help the treatment process.
I heard the member for Brunswick earlier make reference to us not knowing what our future health needs are going to be, and he is absolutely right. It is the case that we cannot necessarily accurately anticipate what it is that we are going to need in future, but better information at the hands of clinicians means better decisions, and that is exactly what this Health Legislation Amendment (Information Sharing) Bill sets out to achieve.
In the context of record investment in the health system and some difficulties with the relationships that patients are having with GPs at the moment and that GPs are having with the rest of the health system, it is so important for us to have a partner in Canberra, and the Andrews government is working very closely with the federal government to make sure that we have a primary care system that dovetails neatly with the secondary and tertiary care options that are available to Victorians. You can only do that when you have got a government that is committed to the fundamental principles of a public health system. The federal government, the Albanese Labor government, is one such government, and we are delighted to be able to work with them on the necessary improvements to make sure that our post-pandemic health system reforms and improves in order to be the very best it can be in order to deliver the quality health care that we know Victorians quite reasonably expect.
Part of that is that commitment to improving patient safety and continuity of care. Those two separate matters are important, continuity of care and patient safety. They are interrelated, undoubtedly, but they are actually separate matters that are both served by better information sharing. Better information sharing means that the risk of providing a treatment that is harmful to the patient is lowered, and it also means that the treatment program for a patient is maintained and is orderly and is understood in the context of all the treatment they have received in the past, even for things like historical injuries. It is difficult for me as a non-medical practitioner to speculate on what things might impact any patient presenting for condition X. It may well be that a prior broken bone is irrelevant when presenting with a respiratory difficulty, but it might be entirely relevant that they had a course of treatment for a peptic ulcer or something and they are now presenting for a respiratory illness. And of course not all patients are going to be conscious at the time they enter the public health system. Not all patients, even if they are conscious, are able to necessarily recall with great detail the totality of their medical history. In that context we ought always to be supporting clinicians with the very best information they can access in order to provide the very best of care.
The structure of the public health system in Victoria is to have these autonomous networks. In my part of the world it is Eastern Health. So whilst that is the appropriate, I think, management model and governance model and resource allocation model, we do know that people are portable, that people will transfer between different parts of Melbourne, and what we need to make sure is that they are able to get that continuity of care irrespective of which part of the public health system they access and indeed even whether they are accessing privately funded GP care, for example. Most patients – all patients – will interact with more than one health service over the course of their lifetime, and you simply cannot anticipate from what has happened to you in the past what is going to be relevant for your future care.
With all that critical health information spread across different health services we get this very fragmented approach, and in order to defragment – I know that the member for Ashwood is very familiar with defragmentation from his days as an IT consultant – the system you need to make sure that there is a single source of truth. That is ultimately what this boils down to: that you have got a dataset that is as complete as it can be and gives clinicians the very best information in order for them to provide the very best of care. Other jurisdictions all, to various degrees, have health information sharing standards, and the model we have had opted for here is opt-out. The bill is not about whether we should actually have that information sharing, it is about establishing the best platform and methodologies, the best rules, for that clinical information to be shared safely, of course being mindful of patient privacy as well as patient safety.
The opt-out model that has been suggested by others, I should say, is a step backwards, and the model we are proposing here is absolutely a step forwards. It will be a step forward in patient care, it will be a step forward in continuity of care and ultimately it will result in a better health system.
Dylan WIGHT (Tarneit) (15:50): Thank you, Acting Speaker Hamer, and may I say how fantastic it is to see you in the chair. I also rise to speak on the bill, and it is an absolute pleasure to do so on behalf of my electorate of Tarneit. Firstly, I would like to thank the minister and her department for the exhaustive consultation with industry and with our healthcare professionals. Also I would like to acknowledge and thank her department for providing a brief to the opposition. On that point, I am still somewhat trying to reconcile the contribution from the member for Benambra just before lunch. As I said, the minister and her department provided an extensive brief. It would appear that the member for Benambra perhaps logged on to that Teams meeting from the front bar of the Benambra Hotel. I would also like –
Danny O’Brien: Benambra is actually in Gippsland East.
Dylan WIGHT: What was that, sorry?
Danny O’Brien: Do a bit of research if you are going to sledge someone. He lives in Wodonga.
Dylan WIGHT: I would also like to acknowledge the contribution from the member for Eureka. The member for Eureka is a staunch supporter and advocate for all workers, but especially those healthcare workers in her fantastic electorate.
The details of this bill and the reason for it could not be clearer. There are a few reasons for it. As the member for Ringwood touched on, we are at the moment at times working with a bit of an archaic data-sharing system through our health services. Obviously the Victorian government is and always has been committed to improving patient safety and continuity of care for all Victorians, and that is exactly what this bill does. It ensures our health services and our clinicians have the appropriate tools and information at their disposal. That (a) improves health care for patients and (b) makes the job of our fantastic healthcare workers, our fantastic nurses, doctors and other healthcare professionals easier.
May I say that those on this side of the house and this government have been working day in, day out to support our healthcare professionals. You just have to go to some of the announcements made prior to the election last November about upgrades to hospitals, new hospitals – a brand new hospital in the city of Melbourne – but also waiving the HECS fees for 10,000 future nurses. That is how you support healthcare professionals and that is how you support our healthcare system; it is not by dog whistling, as we see from some of those on the other side of the chamber.
As has been previously spoken about in this debate, this bill brings Victoria into line with many other jurisdictions in this country, and that is a good thing. We see the same sort of data-sharing services across New South Wales, where HealtheNet has been implemented to secure a statewide clinic portal which shares summary-level patient and clinical information across New South Wales health services. We have seen the same thing in Queensland, where the government has implemented the Viewer, which collates data from multiple Queensland health systems. We have also seen the same in the ACT, where Digital Health Record was implemented, which stores health information for patients who use any of the ACT’s public health services.
What this bill does not do is change a patient’s access to their complete medical records. It does not change their right or rights in regard to FOIs. Patients have the right to access their full medical records from their health provider under FOI and privacy legislation.
Dylan WIGHT: Yeah, no dramas. To ensure efficiency and timely care the information that will be included on the proposed platform is the most relevant clinical data for their treatment and not their medical history. There are also significant security and data controls associated with this bill. An independent oversight committee supported by an advisory group will be established. A primary management framework will be implemented prior to the commencement for limited access to and management of highly sensitive health information, and protections for vulnerable groups like victims of domestic violence will also exist.
For a community like my own, a community with a high multicultural population but also a community that is highly mobile, this bill will be absolutely amazing. I know the constituents that I have spoken to across Tarneit and Hoppers Crossing are wholeheartedly supportive of this bill. As I said, Tarneit is an incredibly highly mobile community. In fact if we go back to COVID, it was the residents of Tarneit who for the most part were deemed as essential workers and who were getting up each morning to travel to work, whether that was in manufacturing industries, logistics, warehousing or anything else. So you see we have a situation with the people of Tarneit. They are leaving their community, so they are leaving where they might ordinarily get their healthcare services from, whether that be at the Werribee Mercy Hospital or somewhere else in Wyndham. They are moving around to go to work and they are moving around to see family. They are moving around our great state for a whole number of reasons. As they move around our great state, if there is an accident, if there is an emergency or if they need to seek medical assistance for some reason outside of where they normally would, this legislation will allow the healthcare professionals that are dealing with my constituents of Tarneit to have their medical history and their medical records – to know if they are allergic to any medications and to know how to provide that care to the best of their ability. Our healthcare workers, I think, provide the best care of any healthcare workers anywhere in Australia.
As I said, the health system, health care, health workers and nurses are something that our side of the chamber take very, very seriously – very, very seriously indeed. In my electorate of Tarneit and in our City of Wyndham the Andrews Labor government, as part of a budget commitment prior to the last election, committed just over $100 million to double the capacity in the emergency department of the Werribee Mercy Hospital – an amazing commitment, and I commend the Treasurer on making it. Werribee Mercy Hospital obviously falls within his electorate, but it is just another demonstration of how seriously we take health care, our health system and our fantastic health workers on this side of the chamber.
I do not have a lot of time left, but obviously there has been a little bit of commentary throughout this debate about the fact that this bill had been introduced to this house previously and is being reintroduced. At times it seems incredibly convenient, and those on the other side seem to forget that there was a global pandemic.
Business interrupted under sessional orders.