Louise Miller-Frost (Boothby, Australian Labor Party) Share this | Hansard source

For many years before I came to this place I worked in the health sector in South Australia. I ran a large number of services across northern and central Adelaide and some statewide services. Another of my roles included recruitment of overseas doctors to rural and remote South Australia, and this was partly because we don't have enough doctors in Australia and partly because many of them don't want to work in rural and remote areas. Many of these basic services—general practitioners who often also cover at the local hospital—were reliant on being able to recruit doctors, nurses, pharmacists and allied health workers from overseas who were required to spend at least a few years in rural and remote areas. Health services are reliant on qualified staff to run, and, unfortunately, as a country we have not been training up enough of them for decades. We also have an ageing population, and often with ageing comes an increased reliance on the health system—bodies wear out, chronic diseases develop, trips and falls become more catastrophic. So we need more of these health professionals, and we needed them yesterday.

There are ethical issues about recruiting precious health worker resources from other countries; they need them as well. The alternative is that we train them up here in Australia, and we absolutely need to be doing that. But it takes time, and we needed this extra workforce yesterday. Our health system is under pressure today from increased demand and from workforce shortages. A doctor takes six years of university study, then an internship. A GP takes a further five years on top of that. A nurse takes an undergraduate degree of three years, and a nurse practitioner takes at least three years experience and then a master's degree on top of that. A pharmacist takes a minimum of four years of study, plus one year of an intern training program. We are not going to be solving our health workforce shortage here in the next year or two through training up additional workers here, although we absolutely need to be doing that.

When I spoke to the now minister for health and ageing a couple of years ago, I was really pleased to hear about the work that was being done on scope of practice across a number of different professions in the health workforce. Today I'm pleased to be able to support the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025. It's a practical, forward-looking reform that strengthens Medicare, supports our health workforce and improves timely access to affordable medicines for Australians no matter where they live.

At its core, this bill amends the National Health Act 1953 and the Health Insurance Act 1973 to allow appropriately qualified registered nurses to prescribe certain medicines under the PBS. It's not a radical step. It is a sensible evolution of modern health care, one grounded in evidence, informed by expert review and driven by the needs of patients. Importantly, it makes the best possible use of our existing health workforce, which is good for patients, is good for the health workers themselves and is good for our overall health system.

The purpose of healthcare reform should always be clear: better outcomes for patients. Today too many Australians struggle to access timely care. In rural and regional communities patients often travel long distances simply to obtain a prescription. In our outer suburbs families can wait days, sometimes weeks, for appointments. This bill addresses those barriers directly by enabling authorised nurse prescribers to prescribe medicines on the PBS. Patients receiving treatment from these clinicians will be able to access subsidised medicines without unnecessary delay. This is about equity, about ensuring that where you live does not determine the quality or speed of your health care and about recognising a simple truth: when patients receive treatment earlier, outcomes improve and pressure on the system declines.

Australia's nurses are among the most highly trained and respected professionals in our health system, yet, for too long, rigid regulatory settings have prevented many of them from working their full scope of practice. This bill changes that. It establishes a formal process through which eligible registered nurses may be approved as authorised prescribers with mechanisms for suspension or revocation if standards are not met. It also ensures that these prescribers are subject to oversight by the Professional Services Review, the same safeguard applied to other PBS prescribers. And, to be clear, this reform expands access without compromising safety. Prescribing will remain contingent on appropriate education, competency and registration requirements already fundamental to safe clinical practice in Australia. In other words, this is reform with guardrails.

But this legislation does not emerge in isolation. It implements recommendations from the Strengthening Medicare Taskforce and the Scope of Practice Review, reforms designed to empower health professionals and modernise primary care. Those reviews recognise what many clinicians already know: Australia cannot meet growing healthcare demand without using the full capability of our workforce. Designated nurse prescribing will help ease workforce pressures, build long-term system capacity and support sustainability across primary care. By enabling suitably qualified nurses to expand their scope of practice, it will also support workforce retention issues. At a time when emergency departments are crowded and GP shortages are felt across the country, we cannot afford to leave skilled professionals underutilised. This is smart reform, the kind that improves productivity while enhancing patient care.

If there is one place where this reform will make an immediate difference, it's rural and remote Australia. The government has been clear: empowering nurses to practice at full scope will provide more equitable access to treatment for people living outside our major cities. As well as running health services across SA, including some rural and remote services, I also lived in a very small country town for a number of years, providing services into general practices scattered across remote SA. Access to timely health care can be a challenge in remote areas and can require considerable planning and travel. Consider the farmer managing a chronic condition hundreds of kilometres from a specialist or an elderly resident in a small town whose local clinic struggles to recruit doctors or the young family who cannot afford repeated travel just to renew a prescription. For these Australians this bill is not theoretical; it's transformational. It means fewer delays, fewer avoidable hospital visits and greater continuity of care within their communities.

The minister's second reading remarks captured the reforms succinctly. Empowering nurses to provide safe, high-quality care directly in the community reduces the need for GP visits and long waits in overcrowded emergency departments. This is precisely the kind of structural reform our health system needs. Too often patients end up in hospital because primary care was inaccessible. Too often GPs spend valuable consultation time on straightforward prescribing tasks when their expertise could be better utilised elsewhere. Allowing trained nurses to manage appropriate prescribing frees doctors to focus on complex care, a win for efficiency and a win for the patients.

This reform also aligns with Australia's longstanding commitment to affordable medicines. The government has stated that the change promotes equitable, affordable and timely access to high-quality medicines and services consistent with the National Medicines Policy. And let's remember what the PBS represents: for generations, it has been a cornerstone of Australian health care, ensuring that life-saving medicines are accessible not only to the wealthy but to every Australian citizen. By expanding the pool of authorised prescribers, we strengthen that system rather than strain it. Access delayed is access denied, and this bill ensures access delivered sooner.

As with any reform, stakeholders have raised questions, particularly about which medicines nurse prescribers may ultimately prescribe. These matters, however, will be determined by the minister through disallowable legislative instruments, allowing appropriate scrutiny and flexibility as clinical practice evolves. This is good legislative design. It ensures parliament establishes the framework while allowing expert guidance to shape operational detail. So let's not let hypothetical fears overshadow the very real benefits this reform will deliver.

Australia has successfully expanded prescribing roles before to nurse practitioners, dentists, optometrists and midwives, always with patient safety at the forefront. And it isn't unknown overseas either. In the UK, most community health visitors have the V100 or community practitioner nurse prescriber qualification. In New Zealand, nurse practitioners have been authorised to prescribe within scope of competence since 2001. In South Africa and Canada and even in all 50 states of the US, nurse practitioners can prescribe. This is not a radical change. It is a well-thought-through logical change with strong guardrails, and it continues to put patient safety and patient wellbeing at the centre of health care.

The National Health Act 1953 has long underpinned the provision of pharmaceutical and medical services in Australia, but a health system built for the 1950s cannot remain frozen in time. Our population is ageing. Chronic disease is rising. Demand for care is growing faster than workforce supply. If we fail to modernise, we risk bottlenecks that hurt patients and exhaust clinicians. This bill is exactly the kind of targeted legislative update required to meet 21st century challenges, not sweeping upheaval but thoughtful adaptation.

Sustainability is not only about funding; it's about structure. A resilient health system distributes responsibility across a skilled, multidisciplinary workforce. It encourages collaboration rather than hierarchy. It removes unnecessary barriers that prevent professionals from delivering care. By building long-term capacity, this reform will strengthen the system for decades to come. Future governments, regardless of political persuasion, will benefit from the foundations laid today, because good health policy should never be partisan. It should be pragmatic.

This is part of a broader vision. The Australian healthcare system, despite its challenges, is world class. If you are sick or injured, you wouldn't want to be anywhere else in the world. But it is a system under pressure, where demand is rising, and so we need to continue to ensure it works to its maximum ability with all the resources, including workforce, that we can provide. This change enacts the vision of a health system where nurses practice to their full capability, patients receive timely treatment, rural communities enjoy genuine healthcare equity and hospitals are reserved for those who truly need them. This is not an abstract aspiration. It is exactly what this legislation advances.

The Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025 is measured, responsible and necessary reform. It empowers trusted professionals. It improves access to medicines. It supports rural Australians. It reduces system pressure. It strengthens Medicare. And, most importantly, it places patients, not bureaucracy, at the centre of care. Parliament is often at its best when it embraces practical reforms that make everyday life easier for Australians, and this is one of those moments. Let us back our nurses and modernise our health system to ensure that every Australian can access the care they need, when they need it, where they need it, no matter where they call home. I commend the bill to the House.

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