Gordon Reid (Robertson, Australian Labor Party) Share this | Hansard source

What we are talking about today is the rates of silicosis and other occupational respiratory diseases being too high. With regard to this National Occupational Respiratory Disease Registry Bill 2023, I will focus on silicosis and silica related lung disease, which comes under the umbrella of pneumoconiosis, a broad term used to describe occupational lung disease.

The issue for patients with occupational lung disease—silicosis, in particular—is that it's quite the spectrum of disease profile. We sometimes have patients early in their disease course who are detected in routine screening or on routine chest imaging, whether that be through chest X-ray or high-resolution CT or whatever the case may be. Alternatively, we have patients that have gradual-onset dyspnoea, which is quite significant breathlessness—initially on exertion, all the way to people being breathless almost as if they've run a marathon and they're only lying in bed. So it is quite the spectrum of disease and is quite the burden of disease on patients, particularly with regard to silicosis and silica disease. Patients can also have quite a significant chronic cough or productive cough and also wheezing. Those patients are more predisposed to conditions like pneumonia, where a patient can become quite septic and can deteriorate and require intensive care.

So those occupational lung diseases like silicosis are extremely debilitating and lethal to patients. Not only that but those diseases and those illnesses require significant amounts of staffing support not only in those acute care settings but also in the chronic care settings and in the home environment. So it's quite a significant cost to our health service and also the economy more broadly.

Looking to those occupational lung diseases like silicosis, we've seen that patients have an increased risk of other diseases as well. So this isn't just a single medical issue that we're looking at. This is a multi-comorbid issue. This is complex chronic disease. It's something that's really costing our patients both in morbidity and mortality. If we look at the fact there's an increased risk of connective tissue disease and vascularity problems with the veins and the arteries in the body, we know there's an increased risk of lung malignancy—lung cancer—COPD, chronic obstructive pulmonary disease and also chronic renal failure. It's not a commonly discussed topic in these settings when we talk about these diseases, but patients can have pulmonary renal syndrome, where the kidneys start to shut down, and patients will require quite significant renal replacement therapy, in the form of dialysis and other medications as well.

From there, we look at the management of that disease and we look at things like oxygen and the ongoing need for pulmonary rehabilitation, multiple different medications and ongoing support from their respiratory physician, which, again, is not only debilitating for the patient but is also costing the patient as well. They're going to the GP more frequently; they're going to their specialist more frequently. That's costing the patient, and that's costing our health economy more broadly.

So that's just a bit of background about silicosis and silica disease and occupational respiratory-related lung diseases—something that I see quite frequently in the emergency department on the New South Wales Central Coast. It wasn't an exaggeration about that patient who I was talking about in the acute bed. It looks like they have run a marathon and they are simply lying in bed. They're attached to all degrees of monitoring and apparatus to ensure that we're monitoring input and output—in particular, those oxygen levels. There are staff everywhere, making sure that that patient is safe and protected against further injury and disease.

That needs to stop. That cannot be the case. The rates of silicosis and other occupational respiratory diseases are unacceptably high in Australia. That is true. Everyone in this chamber knows that. Business knows that. The unions know that. Our healthcare professionals know that. That is why the National Occupational Respiratory Disease Registry Bill 2023 is so important. That's why it is so vital. We are talking about the morbidity and mortality of people. We are talking about our constituents. We are talking about lives, at the end of the day.

These respiratory illnesses caused by occupational exposure are preventable. We have an inciting factor. We have the issue there. That's what's causing the problem. All too often, the deaths that result from these respiratory conditions and the complications that ensue are entirely preventable. That's where this bill starts that journey in addressing these respiratory diseases. Our government, the Albanese Labor government, in consultation with community, with business and with the unions is committed to tackling these respiratory diseases and those occupational diseases that we see—in particular, silica-related lung disease and silicosis.

We're undertaking a suite of reform to ensure that Australia's prevention and treatment measures are world class and that our workers—the workers that make sure our economy ticks and hums—are protected from these unacceptable health risks. So, what we're doing, firstly, is developing a national silicosis prevention strategy and a national action plan, in collaboration with health professionals, with unions and with industry and business, and we're investing in quite significant education campaigns for employers, workers and health professionals to improve prevention, detection and treatment. From the health professional perspective, for a patient who is breathless, or dyspneic, with some other issues, such as chronic fatigue, the list of differential diagnoses is quite significant. Because the rates of those occupational related respiratory diseases are so high in this country, we need to ensure that our frontline healthcare providers, whether in the primary care setting or the acute care setting, consider occupational respiratory diseases at the top of that differential diagnosis. That's so important.

We're also going to be exploring measures to limit the use of engineered stone, including an import ban. And we're going to be working with states and territories to ensure that we have a coordinated approach to keep our workers safe.

The National Occupational Respiratory Disease Registry Bill 2023 delivers on the recommendation of the National Dust Disease Taskforce to establish a National Occupational Respiratory Disease Registry. This follows an increase in silicosis, particularly amongst stonemasons working on engineered benchtops and the like. There are some other incidences of silicosis and silica related lung disease, particularly when silica is heated—molten metal found in foundries or from naturally occurring geological processes. There's exposure to silica in multiple different forms, whether in quarrying and foundries, as I was just saying, or toilet bowls, sinks, ceramic manufacturing, counter tops and benchtops, with abrasive blasting, and cement cutting in construction. So, it is really quite prolific throughout that industry base. That's why it's so important that we protect our workers there and also make sure that our employers are armed with the tools they need to keep their workers safe.

Furthermore, the national registry will capture information relating to respiratory diseases that are believed to have been occupationally caused or exacerbated and will support the use of information to understand the true scale of these diseases in Australia and take action to reduce further exposures in the workplace—so, really making sure that we are gathering that patient data and looking at the true problem within our country of occupational respiratory disease, particularly silicosis. It's going to require medical specialists in the field of respiratory and sleep medicine and occupational environmental medicine who diagnose certain occupational respiratory diseases to notify to the national registry, via an online portal, the diagnosis, the patient and exposure details, to let people know. This is particularly important for our medical staff who are seeing high volumes of patients, particularly in our respiratory and sleep clinics, both in the community and in hospitals. An online portal is important to make sure there is manoeuvrability in that regard. These physicians may also notify of other occupational respiratory diseases, where the individual provides consent. I spoke about pneumoconiosis earlier. That is a broad umbrella term for various other conditions relating to occupational exposure. So we look at things like asbestos, chronic beryllium exposure, making sure that the individual's consent is provided, and then they can notify about those additional diseases as well.

This is consistent with the recommendation of the task force. Initially only silicosis will be a prescribed occupational respiratory disease, and the Minister for Health and Aged Care will be able to prescribe other diseases, following consultation with the Commonwealth Chief Medical Officer and each individual state and territory across the country. In particular, this bill recognises the potential burden that notification will have on physicians and limits mandatory elements that must be notified in a minimum notification. A minimum notification will include sufficient information to identify the individual with the diagnosed occupational respiratory disease—whatever that exposure might be; in this case, silica—and the respiratory disease diagnosed as a result, and details on the likely exposure that resulted in that disease, including the last main exposure. We need to know when that last exposure happened. That's really important.

Additional information can also be supplied where the patient is able to provide consent, which may include relevant medical tests. I was talking previously about pulmonary renal syndrome, where there's an issue in the lungs due to silica, and the kidneys could also be playing up. A patient can supply those medical test results, whether lab biochemistry or further medical imaging through CT or X-ray. They can supply demographic and lifestyle information to look at those comorbid factors and whether the patient smokes or the like. There's their employment status, socioeconomic status and details of each job where the individual believes they've had exposure to that individual agent causing that respiratory issue.

In addition to ensuring notified information is available to physicians treating the individual, the bill will enable the disclosure of notifications about an individual made to the national registry, including to a prescribed Commonwealth, state or territory authority and state and territory health agencies and work, health and safety agencies. The disclosure to those health agencies across the states and territories in Australia is going to increase the awareness of the prevalence of occupational respiratory diseases in the states and territories. It will enable actions to be taken to reduce further worker exposure to those diseases. It will make sure that the workers are protected while also arming the employers to ensure they're protecting their workforce.

Establishing the national registry will complement actions across all Australian governments to reduce exposure in the workplace and demonstrate the government's commitment to keeping workers safe. That's what this bill is about, fundamentally—it's about making sure that we are protecting our workers and, once they've had a diagnosis, protecting our patients and ceasing those occupational exposures. In this case, it's silica. We know it has a profound effect on the human body. It's not only limited to the lungs. It has a wide-ranging systemic effect that not only affects the health of the patient but also affects the health of the family and, ultimately, the community.

See this speech in context