Trish Cook (Bullwinkel, Australian Labor Party) Share this | Hansard source

I rise today to speak in strong support of the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025. The Albanese Labor government is committed to supporting and empowering our health workforce. We are not just talking about strengthening Medicare; we are also doing the hard legislative work and structural reform to make health care more accessible for every Australian, and this bill is one piece of the structural reform puzzle in the healthcare sector. This bill addresses the scope of practice reforms for nurses and midwives. It is legislation that is catching up with healthcare demand and practice and it is backed by evidence and consultation.

Since 2017, the Nursing and Midwifery Board of Australia and the Australian Chief Nursing and Midwifery Officer have undertaken extensive research and consultation about the potential for registered nurses to contribute to improving health outcomes for the Australian community by supporting nurses and midwives to work at the full scope of their practice. Unleashing the potential of a health workforce scope of practice review was delivered to the government on 30 October 2024 after 12 months of consultation and research led by independent researcher Professor Mark McCormack. The review was clear. When health professionals work at the top of their scope, the entire system breathes more easily. It reduces the bottleneck at the GP's door and it allows our doctors to focus on the most complex, high-needs cases while endorsed nurses can manage stable chronic conditions within a clear framework.

In December 2024, Commonwealth, state and territory health ministers approved a new registration standard. It was called 'Endorsement for scheduled medicines—designated registered nurse prescriber' and of course it is under the law which governs nurses and midwives, the Health Practitioner Regulation National Law 2009. The first cohort of registered nurses is expected to complete their education, receive endorsement and start prescribing medicines from July this year, 2026, and this bill aligns with that new registration standard. The Nurses and Midwifery Board registration standard, of course, also has a standard for endorsement for scheduled medications. The designated registered nurse prescriber came into effect in September 2025. The standard describes the necessary qualifications that a registered nurse must demonstrate when applying to the Nurses and Midwifery Board to attain and retain the endorsement for scheduled medications.

I note the Nationals' view earlier today regarding opposition to this bill due to the system being untested. Sadly, this is an uninformed view of the real world. It dismisses the extensive consultation that was done with stakeholders, including the Royal Australian College of General Practitioners, the Australian Medical Association, palliative care nurses of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, and the Australian Primary Health Care Nurses Association. This bill is backed by extensive consultation and real-world experience. It meets the desperate need for better access to care, particularly in primary care and aged-care services.

This bill makes two critical amendments to the legislation. One is the National Health Act 1953. We are amending this to allow registered nurses endorsed against a strict registration standard to be authorised prescribers. This means that they can prescribe certain medications under the Pharmaceutical Benefits Scheme, ensuring that patients get their Commonwealth subsidy regardless of whether a doctor or an endorsed nurse writes the script. The second piece of legislation is the Health Insurance Act 1973. We are ensuring integrity and safety by including nurses in the Professional Services Review. It's a scheme that ensures that prescribing habits are reviewed and held to the highest professional standards, just as we do with medical doctors. This bill isn't just a technical amendment; it is a structural renovation of Medicare and it is fit for the 21st century.

But I note that this reform doesn't exist in a vacuum. For too long, Australia has had a siloed approach to healthcare. We have highly trained professional nurses, pharmacists and allied healthcare workers who are restricted by legacy regulations that no longer match their modern education. My own experience, of course, before I entered this place was as a remote-area nurse. My office wasn't a suite in parliament; it was the corridors of hospitals, it was bush clinics and, in fact, at times it was in the bush itself. I stand here not just as the member for Bullwinkel but as a registered nurse and as the 10th nurse to be elected to parliament. I'm proud to be part of this government that's delivering this reform. I've seen how multidisciplinary teams work best when the hierarchy is replaced by a circle of care. Anyone who has worn the nursing uniform knows that nursing is the backbone of the Australian healthcare system. We are the ones who stay and provide ongoing support to patients long after the medical consultation has finished. We are the ones who monitor the vitals in the quiet hours of the night and notice the subtle changes. And of course we are the ones in primary health care and rural and remote areas where we are, at times, the only clinician for hundreds of kilometres. We are the ones who see with heartbreaking clarity the gaps in the patient's journey, the moments where a delay in the signature or a script leads to an increase in pain or a decline of their health. This bill is about closing those gaps.

I want to share a little bit of my history to illustrate why this bill is so vital. Earlier in my career as a remote area nurse, I didn't have the luxury of 24-hour imaging departments or a local pharmacy just at the end of the road. Many of those communities, of course, exist, and some are regional and remote communities even in my seat of Bullwinkel. To serve those communities, I underwent intensive and additional training to expand my scope of practice. I wasn't just monitoring vitals and taking clinical assessments; I was actually taking X-rays. I was in the darkroom, developing those X-rays. I was taking bloods, making referrals and, at times, prescribing essential medications that were needed to stabilise patients before they could see a doctor or be evacuated. I know what it's like to carry the weight of that responsibility and work within your scope of practice but still give the care that only you can give in a situation like that. I also know the incredible efficiency and safety that comes when a highly trained nurse is empowered to use the full extent of their skills. When I was in these remote area clinics, I wasn't acting as a doctor; I was acting as a highly specialised nurse, delivering the right care at the right time because someone needed it.

This bill takes the spirit of flexibility and clinical excellence and brings it into the 21st century for all Australians. It recognises that the skills that I used in the desert and the bush are skills that should be harnessed across our entire health system to make it more resilient. By allowing designated registered nurse prescribers to operate within their scope after having additional education, we are removing the middleman delay. We are saying to consumers of the health system, 'Your health is too important to wait for a clerical hurdle, especially when we have trained experienced nurses who are available to help and present.'

I want to be clear for those that might have questions about this transition. This reform is about professional evolution, not substitution. This is about recognising the high level of clinical expertise that already exists within our nursing ranks and provides a formal, regulated pathway to use it. The first cohort of these prescribers is expected to finish their specialised education and receive their endorsements by July 2026. These are professional, well-credentialed nurses who have completed rigorous postgraduate-level nursing training.

As a nurse, I know that my nursing registration is my most valuable asset, I belong to one of the most trusted professions in the country, and I adhere to strict clinical guidelines. The endorsement process ensures that only those with the right clinical expertise and education will be writing these scripts. It is a controlled, safe and logical extension of the work that nurses already do every single day to support their patients and their medical colleagues.

We are delivering on a commitment. This is a fundamental election promise made by the Albanese government to prioritise the scope-of-practice reforms for nurses and midwives to deliver real, tangible benefits to Australian patients. This bill is a win for families in Bullwinkel and across Australia, particularly those in regional and rural Australia, who deserve every available option to access their health care efficiently. It is about adding another layer of support to our primary healthcare network and ensuring that, wherever you are—be it in a suburban clinic or remote area—the system is working for you and that you do not have to wait for a doctor to visit, on occasions which are sensible and appropriate. It is a win for the nurse who knows that their patient's needs intimately and can now provide a more seamless transition of care, and it is a win for a more sustainable multidisciplinary health system where every professional—doctor, nurse and allied health worker—is empowered to work at the top of their training.

The Albanese government is committed to supporting our health workforce. As I said at the start, it's not just strengthening Medicare; it is doing the hard legislative work to make it accessible for all Australians. When I look back on my time in my career, this legislation would have been very helpful. Today, I'm proud to be part of the government that's delivering this reform. I commend this bill to the House.

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