The Hon.

Robert Brown MLC

Parliament of New South Wales
Leg islative Council
Shooters and Fishers Party

MEDIA RELEASE
12 May 2016

International Nurses Day Marked by a

Bill to Keep RNs in Nursing Homes
NSW Shooters, Fishers and Farmers MLC Robert Brown marked International Nurses Day by introducing
a bill to reinstate the previous requirement for a registered nurse to be on staff in a nursing home at all
times.
This had been the law in New South Wales for 30 years but was removed as an indirect and probably
unintended consequence of a Federal legislative change.
"Let's have International Nurses Day 2016 remembered as the day in which this House united in support
of the vulnerable in aged care, and the dedicated healthcare workers who tend to them," Mr Brown said.
"Seniors are the forgotten or invisible people in our society, but their needs matter.
"Nobody is or will be spared from the impact of how we treat our elderly people in care- whether it be
somebody's friend, relative or whether they are in care themselves.
"The youngest of my surviving siblings is in residential care, and I know how I would feel if something
happened to them because of an unintended consequence of harmonisation of State and Federal
legislation.
"Reinstating what has been the status quo in New South Wales for almost 30 years will go a long way in
ensuring the safety and wellbeing of people in aged care.
"Without a registered nurse on staff, no pain relief stronger than a Panadol tablet can be administered and
critical incidents can 't be responded to appropriately on-site- instead, an ambulance must be called, thus
pushing the burden onto the public hospital system.
"Quality care must be prioritised before profits- the argument that somehow the world would end if this
was reinstated does not wash. We've had a quality and effective aged care for over 30 years with this
provision in place, so there's no need to change it.
"As of 2011 there were 1.04 million people aged over 65 in New South Wales, and this figure increased
by 22% between 2001 and 2011 and continues to grow.
Debate on Robert Brown's bill, the Public Health Amendment (Registered Nurses in Nursing Homes) Bill
2016, is adjourned for five days while the Upper House considers the bill.
It's currently supported by the Shooters, Fishers and Farmers Party, NSW Labor, the Christian
Democratic Party, the NSW Greens and the Animal Justice Party. The Government is yet to declare their
support.
MEDIA CONTACT:

Robert Brown M LC

Parliament House

Phone: 02 9230 3059 Fax: 02 9230 2613

Macquarie St SYDNEY NSW 2000

email: robert. brown@ parliament.nsw.gov.au

(02) 9230 3059

Robert Browns Second Reading Speech Check Against Delivery

Public Health Amendment

(Registered Nurses in Nursing Homes) Bill 2016
Mr. President, it gives me great pleasure to introduce the Public Health Amendment
(Registered Nurses in Nursing Homes) Bill 2016 a bill that will restore the
requirement for aged care facilities to have a registered nurse on duty at all times,
24/7.
It is also fitting that I am able to introduce this bill on International Nurses Day
where we mark the contributions nurses make to society.
Mr. President, New South Wales has consistently led the way by mandating higher
standards for aged care, because the health and quality of life of people in their
twilight-years matters. Having at least one registered nurse on staff is not an
onerous requirement, especially with the size of some aged care facilities. In public
hospitals we have doctors on-call after hours to respond to critical incidents, but we
do not see anybody wishing to debate this today.
The requirement for having a registered nurse on staff in an aged care facility at all
times has been one that has been a standard in this state for almost 30 years.
Indeed, while this existed in section 104 of the Public Health Act 2010, my staff have
found that this standard goes as far back as the Nursing Homes Act 1988. Section
39 of that Act states:
The licensee of a nursing home shall, at all times while the nursing home is
being conducted, cause a registered nurse to be on duty in the nursing home.
It may go further back, but 30 years for a minimum standard of care should be
sufficient an argument.
I mention this, Mr President, because some of the arguments from peak bodies
representing nursing home operators, or indeed the operators themselves, suggest
that this is a new requirement. That suggestion is blatantly false.
Our present situation came about on 1 July 2014 when the Federal changes to the
Aged Care Act 1997 (Cwlth) came into effect. These were passed in 2013 and were
designed to amend funding arrangements for those in residential care, and to
streamline transfers between low care and high care settings. As an indirect
consequence, the definition of a nursing home in Commonwealth legislation was
removed. This had a flow-on effect to the NSW Public Health Act 2010 (NSW) as it
relied on this definition from the Commonwealth Act.
As a temporary measure, NSW Health Minister Jillian Skinner grandfathered the
status quo in New South Wales to existing aged care facilities under the Public
Health Amendment (Nursing Homes) Regulation 2014. However, any new facility

that commenced operation after 1 July 2014 would be exempt. It surprises me that
the Minister would put so many people at risk by making them exempt from this
safety measure thats been around for 30 years.
Last year, a Parliamentary inquiry through General Purpose Standing Committee No.
3 with Jan Barham as Chair examined this very issue, as well as other regulatory
matters in aged care. My office took a great interest in the deliberations of this
inquiry.
The consensus from the Opposition and Cross Bench was clear: the requirement to
keep registered nurses in nursing homes at all times must be reinstated. Its not
often that youll see the Shooters, Fishers and Farmers Party in complete lock-step
with the NSW Greens, Christian Democratic Party, Animal Justice Party, and the
Labor Opposition.
This bill will right that wrong and it goes about that in a very straightforward manner.
It simply omits the existing definition of a nursing home in the Public Health Act
2010 (NSW) and inserts instead the following:
Nursing home means a facility at which residential care within the meaning of
the Aged Care Act 1997 of the Commonwealth is provided, being:
a. a facility at which a high level of residential care (however described
under or in accordance with that Act) is provided, or
b. a facility of a class prescribed by the regulations.
Since the definition of a nursing home no longer exists, this bill utilises instead the
definition of residential care in the Aged Care Act 1997 (Cwlth), since it remains
tied to Federal subsidies. This also ensures specificity of facilities covered by this
amendment, thus excluding the following:
care provided to a person in the person's private home;
care provided in a hospital or in a psychiatric facility;
care provided in a facility that primarily provides care to people who are not
frail and aged;
care that is specified in the Subsidy Principles not to be residential care.
Mr President, some may wonder why all the fuss about registered nurses. This is a
complex area but I will highlight the main points.
Firstly, a registered nurse can respond appropriately to critical incidents. They have
the clinical knowledge and expertise to be able to assist a resident in their care either
in place of, or adjunct to, paramedic support from an Ambulance if that is indeed
required. A simple two-day first aid certificate at a TAFE college or private training
operator is no match for three years of University-level training, plus 600 to 1,000
hours of practical clinical placement provided by many Bachelor of Nursing courses.
Somebody on-hand who can start resuscitation, or recognise the onset of more
serious conditions and respond appropriately, is essential. Moreover, in the event
that the issue at hand, based on the registered nurses clinical judgement, does not
require a hospital admission, it will prevent an exacerbation of trolley block in our
Emergency Departments.

Secondly, a registered nurse is able to administer Schedule 8 medications. These

are drugs of dependence under our medication scheduling regulations and
essentially cover any pain relief medication stronger than a Panadol tablet, such as
morphine or oxycodone. I cannot fathom any Member of this House wanting to have
a friend or relative or indeed themselves to remain in serious pain because the
appropriate staff member to administer the medication is not on hand. I have heard
whispers that the Government may be wishing to change law on medication
scheduling to loosen these restrictions, but this is simply not on. Current
requirements in aged care mirror those in public hospitals, and this is appropriate for
those in residential aged care, given the risk of polypharmacy, as well as the multiple
comorbidities often presented in seniors.
Finally, registered nurses are equipped with the clinical judgement and assessment
skills to know when and when not to administer a medication. At first glance this
may appear straight forward, but it is the case that enrolled nurses (ENs) and the few
medication-endorsed assistants in nursing (AINs) in residential aged care in New
South Wales do not necessarily have the insight to know when a drug should not be
administered, instead defaulting to the doctors medication order. Medication errors
in this circumstance could be life threatening, such as a blood pressure lowering
medication being administered when a residents blood pressure is already low, or
not picking-up that multiple medications have been prescribed that attack the
kidneys, thus placing the resident at risk of renal failure.
Those opposed to this bill will try and suggest that it will be the end of the world if it
passes and that aged care facilities will be closing across the state. This is a
senseless beat-up and would call into question how we have successfully had aged
care facilities in New South Wales for the last 30 years. What this is really about are
profits. Caps on nursing home bonds have been loosened already and there are
more than enough subsidies under the new system to cover this requirement.
There is no doubt that we have an ageing population. As of 2011 there were 1.04
million people aged over 65 in New South Wales, and this figure increased by 22%
between 2001 and 2011 and continues to grow. Its no surprise that some operators
are dazzled with dollar-signs in their eyes at the prospect of a near limitless
opportunity to profit.
Indeed, in the wake of the changes to the Aged Care Act 1997 (Cwlth) coming into
effect on 1 July 2014, three major nursing home operators, Estia Health, Japara
Healthcare, and Regis Aged Care, floated on the Australian Stock Exchange. Each
of these companies has been going from strength to strength, with Estia Healths
2015 annual report posting $44.6 million in revenue 104.7% of their forecast. This
makes minimum requirements for standards of care by keeping a registered nurse
on staff all the more important.
Mr President, I wish to close on this point.
This bill was not a difficult one to draft. Indeed, barely a full day was needed to be
placed into its formulation. It surprises me, then, that the New South Wales Health
Minister has not acted sooner to reinstate this requirement. Indeed, the cynic in me

would suggest that they were hoping that this issue would just go away and that
people will forget the needs of the elderly. The task has now fallen on the Cross
Bench where the Government has failed to protect our states most vulnerable, and
we will not rest while seniors continue to be our states forgotten people.
I thank Parliamentary Counsel for their assistance with the drafting of this bill, and
my policy advisor John Townsend for championing this issue from my office. He is a
registered nurse in-training himself.
Mr President, lets have International Nurses Day 2016 remembered as the day in
which this House united in support of seniors and registered nurses. Lets keep
them in aged care.