Tim Ayres (NSW, Australian Labor Party, Assistant Minister for Trade) Share this | Hansard source

I move:

That these bills be now read a second time.

I seek leave to have the second reading speeches incorporated in Hansard.

Leave granted.

The speeches read as follows—

HEALTH LEGISLATION AMENDMENT (REMOVAL OF REQUIREMENT FOR A COLLABORATIVE ARRANGEMENT) BILL 2024

Today I am introducing the Health Legislation Amendment (Removal of Requirement for a Collaborative Arrangement) Bill 2024.

This Bill represents more progress on the Government's commitment to strengthen Medicare.

This is an historic day for Australia's healthcare workers.

This legislation represents a major blow—shattering the glass ceiling that—for too long—has held back our highly educated nurses and midwives. In particular those Australian women and men that have taken on years of extra training and study to become nurse practitioners and endorsed midwives.

This Bill is about setting the conditions for those nurse practitioners and endorsed midwives to deliver the care that they are educated and qualified to deliver, allowing them to collaborate in a flexible way when patient needs require it, without limiting their professional scope of practice and autonomy.

It's about continuing to put our hardworking nurse practitioners and endorsed midwives at the heart of the Albanese Government's Medicare reforms.

And importantly, it's about taking necessary steps to unleash the full potential of our nursing and midwifery workforce.

Currently nurse practitioners and endorsed midwives are required to enter into a legislated so called 'collaborative arrangement' with a doctor to be able to prescribe Pharmaceutical Benefits Scheme medicines and to provide services under Medicare.

This creates a litany of issues, limiting their scope of practice, and creating unnecessary barriers to the delivery of care.

In order to demonstrate how significant this legislation is, as a turning point for Australia's nurse practitioners and endorsed midwives, I want to linger on the current situation for a moment, a situation which is not serving workers or the community.

Recently I visited a primary health care clinic in regional Victoria. The clinic has an affiliated Nurse Practitioner that delivers primary health care to a town some 80km away.

This Nurse Practitioner does all the hard yards. She cares for her community. She treats patients. She prescribes drugs she is trained to prescribe, gives advice on chronic disease management like diabetes, manages wounds, looks after sick kids and so on.

However, once a week the GP from the main clinic has to drive to her healthcare centre, to see some patients that are outside the NP's scope of practice, but also to tick a few boxes and sign off on some of her work in order for her and the clinic to attract MBS funding and for her patients to be able to claim the PBS subsidies.

The GP who owned the clinic told me that he values the Nurse Practitioner's work and recognises her expertise and crucial role in the community. The nurse practitioner told me that the system disrespected her work, her skills and her time.

This system has been one of unnecessary and unhelpful rigmarole, it also actively undermines the nurse practitioner's professionalism and inhibits nurse practitioners and endorsed midwives earning capacity.

Instead of our system trusting that nurse practitioners know how to act within their scope of practice and training, just like the system trusts and presumes all doctors do, we have a system that treats her with suspicion and in need of a patronising rubber stamping, wasting everybody's time and precious resources.

In an environment when Australia's health system is groaning at the seams and people—particularly in rural and regional areas—struggle to access healthcare, we need to have every single nurse practitioner and endorsed midwife running at their full capacity.

Because you see, if a GP in a rural town refused to enter a collaborative arrangement, the nurse practitioner or endorsed midwife would not realistically be able to practise, removing a vital access point for the community to quality healthcare and choice.

We need to ensure that a career as a nurse practitioner and an endorsed midwife is fulfilling and well supported, where they are valued for the professionals they are. Where they can practice autonomously, attract an income in their own right, and offer services to their patients that attract the appropriate subsides.

Due to the changes today, we can assure our nurses and midwives that this is what our Government will deliver for you and the people you serve.

This Bill has been a long time coming. I have been campaigning for this alongside nurses and midwives from across the country for many years—decades even.

This is an issue I feel strongly about, as a nurse, and a former Secretary of the ANMF. I know how much this means to the profession.

The bill comes following a recommendation by the Medicare Benefits Schedule Review Taskforce. As a result, an independent review of collaborative arrangements was commissioned by the Department of Health and Aged Care. This included an analysis of Australian and international literature, and extensive stakeholder consultation on the efficacy and appropriateness of collaborative arrangements.

The findings of the independent review supported the need for clinical collaboration between all health professionals, however, found that the current legislative requirements for collaborative arrangements can create barriers to accessing care.

This was not news to our nurses and midwives.

That's why I'm so pleased to be part of an Albanese Labor Government that listens, and makes changes to empower our dedicated, talented healthcare workers.

This Bill will finally remove the legislated arrangement known as a 'collaborative arrangement' between a nurse practitioner or endorsed midwife, and a doctor . This will in turn assist in removing barriers to accessing primary care for Australians, particularly in rural and remote areas, where a general practitioner can be hard to come by.

This Bill recognises that nurse practitioners and endorsed midwives are autonomous professionals who can deliver high quality care to patients within their scope of practice. Nurse practitioners and endorsed midwives will no longer need to have a specified legislated arrangement with a doctor to prescribe Pharmaceutical Benefits Scheme medicines and provide services under Medicare.

Removing the legislative requirement for collaborative arrangements will not impede clinical collaboration or the delivery of care. These health professionals are already regulated by the Professional Standards for Practice and Quality and Safety Guidelines issued by the Nursing and Midwifery Board of Australia, which require collaboration with other health professionals. This is an actionable standard under the Health Practitioner Regulation National Law Act as in force in each state and territory.

Currently, nurse practitioners and endorsed midwives are the only professions that have legislated collaborative arrangements requirements for MBS and PBS access. These changes today will bring them into line with other healthcare professions.

Moreover, the Bill will contribute to the long-term goals of the Strengthening Medicare Taskforce, and the Nurse Practitioner Workforce Plan, and the Woman Centred Care Report—all of which recognise that nurse practitioner and midwifery led care are crucial to ensuring all Australians receive timely healthcare.

And it is not only good for nurse practitioners and endorsed midwives, it's good for women.

We know the care economy—a highly feminised workforce, is often underpaid, undervalued, and underutilised. Women work longer hours for less across our care and support industries.

Economic equality and self-determination is so much harder to come by for working women when the work you do isn't appropriately regarded or remunerated. A Bill that empowers nurse practitioners and endorsed midwives is one that empowers women, taking practical action to reduce the gender pay gap and enhance gender equality.

You don't have to look far into our past to see a world where all doctors were men and all nurses were women.

By boosting the status, financial viability and autonomy of this still highly feminised workforce of nurses and midwives, we are taking a concrete step towards a healthcare system powered by gender equality, rather than continuing to labour under patriarchal norms and default settings.

It's particularly timely that our Government released the Gender Equality Strategy less than two weeks ago—as supporting the more effective use of our predominantly female healthcare workforce will improve gender equality in healthcare access and outcomes.

Throughout consultation on the Women-centred care: Strategic Directions for Australian Maternity Services, it was heard that women wanted greater access to continuity of care. Women feel more cared for and respected if they have a strong and enduring relationship with a single or small team of carers throughout their pregnancy.

The removal of legislated collaborative arrangements will bring us closer to this ideal, by strengthening access to endorsed midwives, including in First Nations settings, aligning with the principles of Closing the Gap through Birthing on Country.

I conclude by reinforcing that the Albanese Government is determined to make it easier for people to access high-quality care where they need it, when they need it.

This Bill will help to deliver this and further the Government's commitment to strengthening Medicare. A commitment that has already seen an historic investment from Labor since we formed Government.

But we won't stop here.

The Albanese Government understands that there is no health system without nurses. And there is no Medicare without nurses!

Removing the red tape that holds back our nurses and midwives from providing the high-quality care that Australians so dearly need will—finally—go some way to recognising this. And it builds on other Albanese Government measures to recognise and support nurses and midwives, like more nursing and midwifery scholarships, opportunities for re-entry to practice, fee-free TAFE, and higher Medicare rebates for nurse practitioners.

Nurses and midwives are at the centre of everything we do. As they should be.

I thank all nurses, nurse practitioners, and midwives and the organisations that support them, for their tireless work and advocacy.

I am proud to fight for nurses in this place, to ensure that every single person in this country recognises their strengths and capabilities. Making practical, structural changes to our health system will go a long way to achieving this.

Supporting nurse practitioners and endorsed midwives to use their skills is good for patients, good for the health system, and encourages more talented people to take up these professions.

Australia's health care system is powered by the sweat, hearts and expertise of nurses and midwives.

It's time to let them deliver the work and care that they were trained to deliver.

NATIONAL CANCER SCREENING REGISTER AMENDMENT BILL 2024

The need for this National Cancer Screening Register Amendment Bill 2024 arose from the 2023-24 Federal Budget announcement 'Tackling smoking and vaping, and improving cancer outcomes'.

Under this measure, the Government announced a $263.8 million investment for a new National Lung Cancer Screening Program commencing in July 2025 to support earlier detection of lung cancer, when treatment is likely to be more effective. Part of this allocation includes expansion of the National Cancer Screening Register to support delivery of the new Program.

While advances have been made in the diagnosis, treatment and care of people with lung cancer, it is still the leading cause of cancer-related deaths in Australia.

Compared to most other cancers, the survival rate of people with lung cancer is poor. On average, only one in five people diagnosed with lung cancer survive five years after diagnosis, compared to a five-year relative survival rate of more than 70 per cent for all cancers combined.

Indigenous Australians are twice as likely to be diagnosed with lung cancer compared to non-Indigenous Australians.

They are also twice as likely to die from lung cancer compared to non-Indigenous Australians.

In addition to Indigenous Australians, people living in remote, very remote areas and areas of greatest socioeconomic disadvantage are disproportionately affected by lung cancer, with higher lung cancer incidence and mortality in these populations.

For many people, the impacts of long-term smoking have increased their risk of developing cancer and other health complications. This is why the Government is taking action in line with the National Tobacco Strategy 2020-2030 through stronger legislation, enforcement, education and support to prevent the uptake of smoking and vaping, and to encourage people to quit.

The Public Health (Tobacco and Other Products) Act 2023, passed by the Parliament in 2023, consolidated the existing Commonwealth tobacco control framework into one Act. It modernised and simplified the existing provisions and allows us to introduce new measures to strengthen our response to smoking and to prevent the promotion of vaping and e-cigarettes. The introduction of reforms to protect Australians, particularly young people, from the emerging harms of vaping and nicotine dependence, is the next step.

At the same time, the Government is focussing on education and support. The 2023-24 budget included $63 million for public health information campaigns to discourage Australians from taking up vaping and smoking and encourage more people to quit. A further $30 million was invested in support programs to help Australians quit.

These measures aim to address the significant threat to public health caused by cigarettes and vaping. We want to do everything we can to avoid people suffering from preventable lung cancer.

The good news is that if lung cancer is detected at an earlier stage, it is more likely to be successfully treated, leading to better outcomes for individuals as well as the larger community.

The aim of the National Lung Cancer Screening Program is to reduce the burden of lung cancer in the community—including incidence of the disease, morbidity from the disease, or mortality from the disease. The Program will facilitate this by detecting lung cancer earlier than would be the case in the absence of screening, thereby improving health outcomes.

The Program will target asymptomatic individuals aged 50 to 70 years with a history of cigarette smoking of at least 30 pack-years, and if an individual has a history of cigarette smoking, has quit within the past 10 years.

Through the Program, eligible at-risk Australians will be able to get a lung scan every two years, as recommended by the independent Medical Services Advisory Committee, and follow-up scans if there are any findings.

A 'positive' screening test identifies people who are at increased likelihood of having lung cancer and who require further investigation to determine whether

they have the disease. Participants will be encouraged to screen regularly so signs of lung cancer can be detected early.

The new screening program is expected to prevent more than 500 lung cancer deaths every year.

This Bill will amend the National Cancer Screening Register Act 2016 which provides the legislative framework for the operation of the National Cancer Screening Register. Specifically, the Bill adds 'lung cancer' to the definition of 'designated cancer' and as a result, expands the scope of the Register.

The Act established the National Cancer Screening Register as a register of information about screening associated with certain types of cancer for the purpose of supporting cancer screening programs. The Register commenced operation in 2017.

The Act was drafted in such a way that new cancer screening programs could be added to the scope of the Register in the future, through amendments to the definition of 'designated cancer'.

Currently, the designated cancers in the Act are bowel cancer and cervical cancer, to allow the Register to support the National Bowel Cancer Screening Program and the National Cervical Screening Program, respectively.

Inclusion of lung cancer as a 'designated cancer' in the Act will make the National Lung Cancer Screening Program the third cancer screening program to be delivered by the Register.

The Government recognises the opportunity to leverage the Register to facilitate a national approach to lung cancer screening. Expansion of the scope of the Register to the new Program will enable a consolidated source of lung cancer screening information to be maintained and used to support the screening program.

The Bill will provide the legislative basis for the Register to deliver the Program, including handling of program participants' personal and sensitive information in connection with lung cancer screening and diagnoses.

The Bill will effectively expand the Register's purposes that are already in place for the bowel and cervical screening programs to the new National Lung Cancer Screening Program.

For example, to support continuity of care, the Register will generate advice and screening reminders for program participants and their nominated healthcare provider about when an individual is due to undergo a lung scan. If required, reminders will prompt an individual to see their healthcare provider following a lung scan. Depending on the participant's risk profile, the provider may refer the participant for a follow-up lung scan.

The Register will support healthcare providers by providing them access to patients' lung cancer screening information, for the purpose of providing healthcare.

Program participants will have access to their lung cancer screening information in the Register and be able to update their participation in the Program, such as deferring their screening or opting out of the Register.

As a repository of information about lung cancer screening and diagnoses, the Register will support monitoring of the effectiveness, quality and safety of lung cancer screening to improve service delivery of the Program.

There are other efficiencies that can be gained by building on the current functions of the Register to support lung cancer screening. For example, the Register already inter-operates with GP clinical information systems to enable healthcare providers to provide data to the Register, as well as access to screening information in the Register to better inform clinical decision-making.

Importantly, adding lung cancer as a designated cancer will extend the

limited authorisations and exceptions in the Act to ensure that personal information is only collected, recorded, used or disclosed to or from the Register for specific purposes.

It should be noted that, apart from these legislative protections and restrictions, the Register Operator is required to operate the Register in accordance with strict security requirements. Through this Bill, the existing identity and user access management solutions and security protocols will be expanded to lung cancer screening information held in the Register.

The Government is serious about increasing the number of Australians who participate in cancer screening as part of the fight against cancer.

The National Lung Cancer Screening Program, in particular, is being designed to underpin the principles of access and equity. That is why a key element of the Program includes two new Medicare Benefits Schedule items for lung cancer screening which will be available from July 2025 to enable scans to be delivered at no out-of-pocket cost to patients.

The National Lung Cancer Screening Program is being co-designed with and for First Nations people to ensure the program is culturally safe and appropriate, and mobile screening and patient travel support measures are in development to increase access to the Program—including to support Australians in rural and remote locations with limited access to these services.

Other key activities underway to support the Program include development of program guidelines, workforce education and training materials, a quality management framework and a national communication strategy.

While the Program will impact our health system, it is not anticipated to increase the patient pool, but rather reduce the current impact of treating advanced stage cancer patients and palliative care patients. The Department of Health and Aged Care continues to work with states and territories on implementation of the Program.

Passage of the bill in the Winter sitting will enable sufficient time to scale up the Register, undertake consultations with healthcare providers, build additional clinical software interface, and deploy the Register to support the National Lung Cancer Screening Program from July 2025.

I commend the Bill.

Debate adjourned.

Ordered that the bills be listed on the Notice Paper as separate orders of the day.