MS TIERNEY (Western Victoria—Minister for Training and Skills, Minister for Higher Education) (17:51): I move:
That the second-reading speech be incorporated into Hansard.
Motion agreed to.
Ms TIERNEY: I move:
That the bill be now read a second time.
Incorporated speech as follows:
Introduction
Non-emergency patient transport sector and commercial first aid providers play an important role in our health care sector. In 2018/19 the private non-emergency patient transport sector (NEPT) transported 355,000 Victorians of which 155,000 were for Ambulance Victoria. Commercial first aid providers provide a range of support services for sporting and other events.
That is why this Bill aims to improve safeguards for these sectors. The changes proposed recognise that it’s not ok to cut corners when it comes to health and safety of patients and hard-working non-emergency patient transport officers. Unfortunately, there have been examples of a small number of operators who have not put patient safety first.
The Bill is expected to result in poorly run service providers either lifting their standard to meet the safeguards or leaving the market.
The changes proposed are the result of a review of the Non-Emergency Patient Transport Act 2003 (the Act), which had not been reviewed since it was established. Given the role of NEPT during the COVID-19 response in providing transport services this review is timely.
The changes strengthen compliance and enforcement for the NEPT sector and promote the safety and quality of care for patients.
The penalties have been reviewed—this review showed that the current penalties for major offences are consistent with penalties applied to private hospitals for major offences and penalties for certain minor offences will be increased. I am confident that these penalties send a clear message that non-compliance is not tolerated.
They also enable unannounced inspections of vehicles when on road, typically at hospital entrances and emergency departments (snap audits), so vehicles can be checked to see whether they are fit for purpose, not out of date, and they are carrying vital safety equipment such as power lift stretchers and lifting cushions to minimise injury risks for patients and vehicle crews.
It also means Victoria will be the first state to introduce safeguards for the commercial first aid sector. By establishing a regulatory framework, it means that those who can’t meet the standard will not be able to provide services to the community.
I am pleased to advise that during the process of the review, key stakeholders including sporting groups who engage first aid services, Ambulance Victoria and first aid providers were supportive, recognising the need for safeguards to protect the community from poor operators.
The Bill enhances patient safety and quality care in two ways; by giving the Act a new focus on safety and quality; and establishing a new regulatory framework for first aid services.
Patient Safety and Quality
To give a greater focus on safety and quality, the Bill introduces a new purpose for the Act. It gives it a single new purpose, to promote the safe provision of non-emergency patient transport services and first aid services and good quality of care of patients in the provision of those services, and providing for a licensing system for those services and otherwise regulating those services. The purpose aligns with the recommendations of the 2016 Targeting Zero report and means that there is consistency between the non-emergency patient transport and commercial first aid services and Victorian private hospitals.
Non-emergency patient transport and commercial first aid services are a part of a patient’s journey through the Victorian health system, and so providers should be accountable for the delivery of a safe service with suitable quality of care in the same way as hospital services and ambulance services.
To do this, when applicants apply to be an NEPT provider and when their licences are renewed, they will be assessed on whether:
• they can deliver safe services, whether they can foster on-going improvement of the quality of their service; and
• suitable clinical governance arrangements, and management and staffing arrangements are in place.
To enable service providers to have minimum competencies, and to enable vehicle crews to maintain their skills, like other health services, non-emergency patient transport services will need to deliver a minimum number of services over twelve months, otherwise patients will be put at risk. The number of 250 was arrived at following extensive consultation with the sector.
It is proposed to introduce a power to approve accreditation schemes and standards that must be followed by the sector to drive quality and safety improvements to services and staff safety in the sector. It will enable the sectors to continuously improve and keep up to date with modern clinical standards.
During COVID-19, non-emergency patient transport services were called upon to provide transport for aged care residents and hotel quarantine returned travellers to ease the pressure on ambulance services. Under these arrangements there would be an opportunity to enforce the adherence to the National Health and Medical Research Council Infection Control Guidelines 2019 to set a minimum standard in infection control.
This would also enable the approval of an occupational health and safety scheme which would require all non-emergency patient transport licence holders to achieve accreditation to that scheme. This would improve the safety of employees and deliver a key component of the government’s commitment to the workers of this sector.
Closing loopholes (NEPT stand by licence and paramedic title)
In reviewing the Act, we have identified loopholes that need to be closed to promote safety and to make sure the community know what level of service they are getting. One of these is non-emergency patient transport service licence holders who provide stand-by services at public events that are in fact providing first aid services and have no intention of ever transporting patients. Going forward these providers would be required to hold a first aid licence.
Unfortunately, I have heard that some operators are using the paramedic title in their business names. Paramedics perform clinical procedures, administer drugs and maintain patient records.
To stop misleading representation, the use of the term “paramedic” in business names, descriptions, or on any vehicles used to provide non-emergency patient transport services or first aid services will be banned.
Additional compliance and enforcement tools
To further safeguard the community from poor operators the amendment also provides for proportionate powers to suspend or cancel a licence if it is determined a service or a class of service poses a serious risk to patient safety.
The purpose of suspension of a licence is to protect patients and to give the licence holder the chance to rectify the identified risk to minimise damage to the business. However, if the risk to patients is too great, or minimum safeguards can’t be met like poor staffing arrangements or not adhering to approved clinical standards; the new provisions will enable the licence to be cancelled.
It also enables for spot audits to make sure that safeguards are adhered to while operators are providing services to the community.
First Aid
The first aid sector is currently unregulated. Under this Bill, commercial first aid providers will be subject to similar regulatory requirements to non-emergency patient transport providers I have described previously.
While it is a big step to regulate an unregulated sector, given the range of services provided to the community by commercial first aid providers, setting a minimum level of safeguards is critical.
Pre COVID it was estimated there were about 90 organisations operating commercial first aid services, which include bandaging of minor injuries and low-level pain relief, to major trauma stabilisation prior to ambulance transport, to provision of general anaesthesia and intravenous sedation for drug overdoses. These services are often provided at festivals and sporting events. They are an important part of our health service system.
There have also been reports of a small number of unsafe operators which mean this sector requires oversight. This includes some first aid providers turning up at serious road accidents before the emergency services and commencing significant intervention treatment and other reports using the word “Paramedic” when the staff are not trained or registered paramedics.
At some music events general anaesthesia and intravenous sedation is provided to patrons who have overdosed. Provision of general anaesthesia and intravenous sedation is a practice that carries significant patient safety risks and is usually performed in a hospital setting where there is substantial medical support. In 2018 the Government introduced legislation to control the delivery of general anaesthesia and intravenous sedation in dental clinics to ensure patient safety following a death in a dental chair in 2017. Similar controls should also be applied to the first aid sector.
These examples alone, and the range of services provided, justifies the need to introduce safeguards to require sub-standard and possibly unsafe operators to meet the required standards or leave the industry, and to make sure the first aid sector is clear about what services they can and can’t provide. It will also give confidence to the community that organisations providing commercial first aid services have met safety and quality standards.
The regulatory requirements are proportionate to the type of service provided so that providers who provide major trauma stabilisation will be required to meet a higher level of safeguards than those dealing with minor injuries. The licence fees will be determined after consultation with the sector.
I am pleased to say the licensing and regulation of first aid providers is supported by the sector because it introduces minimum patient safety and quality of care standards which will give the community trust in the sector, and it will remove poor or unsafe operators.
During the public consultations we heard from one first aid company that “self-regulation has led to ‘fly by nighters’ undercutting quality First Aid Providers … operating without any form of insurance, resulting in substandard first aid facilities and services.”
We also heard that sporting clubs, who often rely on these services, welcome these new safeguards. One peak sporting organisation’s submission supports “an outcome where clearer definition of authorized medical services provided to a common standard. In addition, a system where staff of medical providers are clearly defined and categorized to their level skills and qualification. Providing a scope of practice which can be easily understood by sporting bodies and sporting clubs.”
Those accessing these services, like councils, sporting groups and event organisers will also be able to check whether the organisation they are hiring meets these minimum standards by the establishment of a public register.
The requirement for licensing will apply to commercial first aid providers only. Those who do not charge a fee such as volunteer first aid providers, such as parents at their children’s sporting events, and organisations such as Life Saving Victoria will be exempt. Including volunteer first aid services in the legislation would be likely to see the withdrawal of those services leading to the cessation of many community sporting activities. Companies that directly employ staff to provide first aid at business premises such as mines will also be exempt.
Implementation
I recognise that setting new regulatory requirements on any sector will mean an adjustment for existing non-emergency patient transport and commercial first aid providers. While this will take effort, the need for safeguards is compelling and I know there was support for these changes by the sectors for this reason.
This transition will be a shift for the commercial first aid sector, given it is the first time they will need to participate in a regulatory scheme. That is why there will be a transition period of 12 months to be licensed after introduction of the amendments, given they are currently unregulated.
New requirements for the non-emergency patient transport sector will be introduced from 1 September 2021, noting that they already participate in a regulatory scheme, and given the volumes of services provided to the community there is a need to establish additional safeguards as soon as practicable. Those businesses that currently use the word “paramedic” in their business name will be given two years (a licence cycle) to change their name. For other changes such as the new requirement for clinical governance, the department will work with licence holders to help them achieve the required standard prior to September 2021
My department will offer support for all affected sectors including guidelines and fact sheets and will run information sessions to make sure there is an understanding of the safeguards. Information will also be offered to event providers who use first aid companies when the legislation is enacted so they know how to access providers who meet the standards.
Subordinate regulations
Amendments to the Non-Emergency Patient Transport Regulations 2016 will be developed as will new First Aid Regulations. These will give greater detail to the regulatory tools and framework. It is intended the new Regulations will come into effect at the same time as the amendments to the Act which is 1 September 2021.
The Government has also committed to introducing power lift stretchers as this will mean a reduced likelihood of injury to staff, and this will be introduced through subsequent regulatory amendments. As this is an expensive item, NEPT licensees will be given three years to convert their fleet.
I commend the Bill to the house.