Mr DEAN ( Windermere ) - Madam President, I will not be speaking for long on the bill but there are some points I want to make. I thank the Government for the briefings today right across the board from all sides and, not being disrespectful to anybody, but I was probably getting a bit briefed out after spending a long time in there.

Mr Parkinson - Likewise.

Mr Wilkinson - Did you feel like saying, 'Pull up your briefs'?

Mr DEAN - Yes, but I do thank the Government for those briefings.

I walked into the briefing this morning with almost a position of not wanting to support the bill. I have now changed somewhat on that position but I will still listen to the rest of the debate because there are some areas I am uncomfortable with, to say the least.

One thing that does give me a little comfort is the fact that we have built in the two and the three-year review period. That will occur, as I understand, in the implementation of this bill if we support it. So that in itself I think, Madam President, will cause those people, if the bill is supported, to be very careful with the administration of it and with the operation of the bill. I think they will be very careful to ensure that everything is going according to plan and going in accordance with the advice that we have been given because if it did not, it is highly likely that a review would demonstrate some of that. I think it would be remembered by members in this House some of the comments that have been made and I will refer to a few of those as I go through. That does give me some comfort. We were told during the briefings this morning that no EN or RN, enrolled nurse or registered nurse, will lose their position as a result of this bill. That is as I understand it; we were told that.

Ms Forrest - You can only claim that on those facilities that were represented there.

Mr DEAN - Absolutely, and that was a point I was going to make. I would be more comfortable if that was the position from all of the aged homes within the State but it is not. I really do feel uncomfortable about it and that is one of the concerns of the ANF - Australian Nurses Federation - that it would see an exodus of nursing staff from these areas and it would impact on career paths and it would impact probably on the employment of some of these people. That is a real concern to me.

Time will tell as to whether or not that does happen. If it does happen, that will be an extreme disappointment to me and to a lot of other people and I think it will impact on the credibility of some of those people who have passed that information on.

The ANF is wanting a position that provides the best and safest position for those requiring medication. Aged care has been a dominant factor in this the whole way through, and the ANF have focused very clearly on that side of it; they want the safest and the best position for those people who are in these homes who require support and medication.

I am satisfied that it is not about the ANF wanting to protect their domain. This organisation is a credible organisation. I have the greatest admiration for the ANF and our nurses, and in particular the CEO of the Tasmanian branch, Neroli Ellis. I think they do a wonderful job in supporting health in this State and wanting the best positions available for their nurses, their people, and with the safest and the best service to patients that they are responsible for.

Administering medication is more than just handing a patient their tablets. There is a lot more to it. It is also about making an assessment of them at the time this occurs. It is talking about them, taking in their appearance, it is making a medical assessment of these people at the same time.

Ms Forrest - No, a nursing assessment.

Mr DEAN - A nurse, yes.

Ms Forrest - Nurses make nursing assessments.

Mr DEAN - Sorry?

Ms Forrest - It doesn't matter.

Mr DEAN - Okay. The nurses in administering these drugs would be making some form of assessment and we were given an example this morning of the 85- or 87-year-old lady who was demonstrating some other medical problems at the time that she was being spoken to by an RN or an EN. It was noticed that she had other symptoms. They were able to, as a result of that, ensure that she was given the urgent treatment that was necessary to allow her to get on top of those problems.

Will staff in an aged care facility have that same ability? I do not know. I think we were told in the briefing that they will.

Mr Parkinson - I thought that example was in a nursing home and it was the carer who brought the problem to the nurse's attention.

Ms Forrest - It was.

Mr Parkinson - It was given as an example of where the system works properly.

Mr DEAN - The point I am making is that the time of giving medication is more than just handing out the medication. There are observations and all of those things that go with that as well.

Mr Finch - There was something that we were given today showing when people go through certificates III and IV, the different things that they learn through that process of building their skills and the things of which they need to be aware. Those things were taken into account and they will not be doing it unless they go through that process anyway. It is skills they do not have now, but they will require them.

Mr DEAN - That is right and that is a good point. I accept the point you are making. I am not convinced that there will be a qualified nurse or an RN on duty at all times. This was discussed during the briefing. I questioned the aged care person on this and I do not know whether or not I originally got it right or wrong. However, I initially believed that, from what we were being told, 'available' meant that there would be a qualified nurse on duty at all times. The further we got into that it became abundantly clear to me that that was not the case and will not be the case, but that a qualified nurse will be on call. On call could well be 20 minutes away. It could well mean three-quarters of an hour or an hour away. It could be some long distance away. I would suspect in those cases they would be paid an on-call allowance. Therefore they would need to be in a position to respond to a call back to the aged home. That is the concern and that is the concern of the AMA. The AMA's real concern is that there will not be qualified nurses on duty in these homes at all times. That is one area about which they are extremely uncomfortable and about which they make comment.

Is being 'available on call' the right situation for an aged home where you have 60, 80, 100 or 200 residents? Is it? I do not feel comfortable with it. I suspect there are many others who are not comfortable with that.

The letters have been referred to and we have received many of them. The member for Nelson is not here but he is probably listening in. Instead of referring to about 10, I intend to read about 20. I will not do that to you but I do want to make comment on two of them. The member for Launceston referred to very important e-mails. There are just two to which I want to refer. Once again, I do not have the say-so of these people to release their names, and I will not do that. However there is one, which all members would have received because it was addressed to all Legislative Councillors:

'I have worked as a Community Nurse for over 25 years as a Generalist Community Nurse and a Palliative Care Nurse, please know that with my vast experience, I have grave concerns for our elderly patients/residents.

Aged Care Services of Tasmania says allowing carers to give medications will "free nurses up to do nursing".

Medication administration is an integral part of nursing. It requires extensive knowledge of medications and good assessment skills. Working in the DHHS as a Registered Nurse we are required to prove medication competency annually.

Carers will be allowed to administer medications, including some narcotics, without RN onsite and by any route.

I would not like any relative of mine to be put in this situation.'

There are other comments and statements made in that e-mail.

Another e-mail from which I will take a short quote says:

'As an enrolled nurse in aged care I am appalled and disgusted with the new amendments.

I won't be furthering my Career nor assisting nor supporting Carers giving out medications at any time under this new legislation.

I will be with others working with Unions not to support and cover the liabilities that occur with workers who are not registered with the NBT.

Maybe this is one way of quickly decreasing the Elderly population that poses a problem for our country.'

She refers to the liabilities, and I did raise that this morning during the briefing. I still have not been given an absolute answer on what liability rests with these aged carers when providing and giving medication in this situation if this bill gets through. Are they themselves liable? Will it be the nurse that has some responsibility? Will it be the aged care home? And what sanctions can occur? I do not know and I do not think that is covered in the legislation anywhere.

Do we just ignore the many e-mails we receive? Do we say that they are all wrong? Do we say that they all have a misunderstanding of this, that they do not appreciate what it is about? Is that the way that we do it?

I cannot ignore them because many of these people are working in the profession so one would expect that they would have a very good knowledge and understanding of it. It is difficult to simply dismiss them.

The member for Launceston raised an issue when he talked about the freeing up of the qualified nurses in these facilities. I think that we were told this morning that 40 per cent to 50 per cent of a nurse's time is taken up in administering drugs.

Mr Parkinson - Up to 50 per cent, I think they said.

Mr DEAN - If the work that they are now doing is going to be moved across to the aged care staff that is currently there, does that mean that they have been underemployed all this time or does it mean that there will be a lot more of these staff employed? It is an interesting point. I am not quite sure what it will mean. Or does it mean, as the member for Launceston suggested, that there will not be as much care or as much work done by those people because they will now be administering these drugs?

Perhaps the Leader might be in a position to give me some information as to what that will mean at the end of the day.

We were told this morning if this bill is supported, if it gets through, more elderly people will be kept out of the hospitals. As we are all aware, in the current select committee inquiry into public hospitals issues have arisen in relation to aged care facilities, for instance the number of beds available and the number of aged people that are currently taking up beds in public hospitals. It is hard for me to ignore that potential benefit when we know that our hospitals are bursting at the seams. If the bill could achieve that it would be difficult for me to not be swayed at this stage towards supporting the bill. Provided patient safety is not compromised in any way and provided our qualified nurses are not adversely impacted on in any way I can probably support the bill.

Having said that, I have asked myself would I prefer to be administered drugs, narcotics and poisons by a qualified and registered nurse or by a carer in an aged facility. It is not a very difficult question to answer. I would prefer to have the qualified, registered nurse administering drugs to me. I think we would all answer it that way.

I cannot understand why the AMA have the view they have. It is a pretty strong position. When you look at the document provided to us and from which they read this morning, they got it absolutely wrong as well. I quote from that document:

'The AMA position is very simple and based around one issue.

It is our understanding that should the Poisons Amendment Bill (No. 2) and Poisons Amendment Regulations 2009 be adopted in their current forms it will be possible for high care facilities to operate shifts without nurses on site. We do not believe that this is workable and have not been provided with any evidence that says it is. For this reason we support the ANF's call for guidelines to be developed for the AgedCare sector that requires a nurse to be on site at all times and that these guidelines be incorporated into the Regulations.

We have no problem with appropriately trained medication-endorsed carers administering routine drugs provided they are packaged in a way that makes this safe …

What we do not support is nursing homes operating without nurses'.

It is a fairly clear position being espoused by the AMA, and the reasons they have some concerns about it.

The other document referred to this morning has the comments of Miss Jo Hardy, the Chief Executive Officer of Mary Ogilvy Homes Society, to a Senate committee on Friday 27 March 2009. That is fairly recent and it is pretty difficult to refute what this lady is saying. There was some comment made on it this morning. The document reads:

'Here in Tasmania our Poisons Act determines that an awful lot of our medication and management has to be undertaken by a registered nurse. We are not in a position, as they are in Victoria, New South Wales or various other states, to use the medication endorsed for extended care assistant. In our facility, we only have 80; we are fairly small. The hourly difference between a registered nurse and a carer is around $11.20 a day.'

I think 'a day' is meant to be 'an hour'. I think there could well be a typographical error there.

'If this legislation were brought in and if we were on a par with other states, we would probably be in a position of saving around $40,000 a year. That is a fairly accurate costing'.

This lady has not said that these ENs would be able to work more closely with the patients and would be able to provide a better service and bring more business into these homes and therefore they would increase the income into these aged care homes. She has not said that. So I take it from the comment made there, that the saving would be made in other ways.

There is only one way that I can read from that that the saving may be made. I may be wrong but I would be interested to hear if any other person has a comment on that.

Having said that, I am bewildered and confused, and not quite sure where I should go with this bill. I think I will be waiting to hear from the Leader in his response to the second reading debate and perhaps from other members who are probably yet to come in relation to this bill.