Melissa McIntosh (Lindsay, Liberal Party, Shadow Minister for Women) Share this | Link to this | Hansard source

I rise to speak on the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025. This bill enables eligible registered nurses to prescribe certain medicines under the Pharmaceutical Benefits Scheme. It establishes a framework for approving authorised nurse prescribers, including safeguards that allow approvals to be suspended or revoked where necessary. It also formally recognises authorised nurse prescribers as a new category of PBS prescriber, ensuring that patients receiving care from authorised nurses can access medicines under the PBS.

Registered nurses make up around half of Australia's health workforce. They serve communities right across the country, including in rural, regional and remote areas, where access to doctors can be limited and where healthcare workforce shortages are most acute. Expanding scope of practice in a safe and regulated way has the potential to improve access to medicines, particularly for Australians living outside metropolitan centres.

The introduction of nurse prescribing follows extensive consultation and regulatory development through the Nursing and Midwifery Board of Australia. An agreement among health ministers and the first cohort of nurses is expected to begin prescribing from mid-2026.

The opposition won't stand in the way of this bill passing the House. On its face, the bill is broadly consistent with the objective of ensuring Australians have timely and affordable access to essential health care, particularly in rural and remote communities. However, as always, the details matter. We will be carefully examining the implementation of these arrangements through the upcoming Senate Community Affairs Legislation Committee process and considering any issues or amendments that arise once the committee reports later this month.

While this bill deals with prescribing arrangements, it sits within a broader challenge facing Australians—the rising costs and challenge of accessing healthcare. Australians relying on prescription medicines are facing increasing healthcare costs under this government, including the highest out-of-pocket GP fees on record. Patients are now paying, on average, more than $50 out of pocket simply to visit a GP. For many Australians, especially families and those managing chronic conditions, healthcare costs are becoming harder to absorb, particularly amongst the broader cost-of-living challenges impacting household budgets right across this country. Labor's mismanagement is forcing Australians to make difficult decisions about their health—decisions no Australian should ever have to make. We're seeing more Australians delaying doctor visits or putting off refilling their scripts because they simply cannot afford it.

The coalition and, of course, the opposition have always supported affordable access to medicines through a strong and sustainable PBS. Our record shows consistent investment and reform to ensure Australians have access to the medicines they need at prices they can afford. Supporting appropriately qualified registered nurses to prescribe PBS medicines is consistent with that commitment to improving access and affordability. But access is not just about who can write the prescription; it is also about whether medicines are available to Australians on the PBS in the first place, and, on this measure, Australia is falling behind.

Despite growing healthcare needs, investment in the PBS fell in real terms in the 2024-25 financial year under the Albanese government—a decline of almost $200 million compared to the previous year. This stands in contrast to the record of the former Liberal-National government, which approved more than 2,900 new or amended PBS listings, with investment totalling around $16.5 billion. Meanwhile, Australians are waiting longer than ever for new medicines to become available under the PBS. On average, it now takes around 466 days after registration for a medicine to be listed. That is more than a year's delay. Behind those numbers are real people waiting for treatments that could change or even save lives. Patients, clinicians and industry stakeholders consistently tell us that Australia's system for approving and funding medicines is slow, outdated and overly complex. The health technology assessment review was commissioned to fix precisely this problem, yet, more than 600 days later, many of its recommendations are still sitting unanswered. This review represents a critical opportunity to modernise our processes so they remain world class, responsive to innovation and genuinely patient centred. That opportunity must not be wasted.

While we support enabling nurse prescribers to prescribe PBS medicines, we also condemn the government's broader failure to ensure Australians can have timely and affordable access to life-saving and life-changing medicines. This bill also intersects with a broader discussion across the health sector regarding scope of practice reform. There is significant interest in the government's response to the scope of practice review and what it means for workforce reform across the healthcare system. We view this process as an opportunity for the government to provide a clear roadmap for reform. When health professionals are enabled to work to the full extent of their training and capability, patients benefit through improved access and more efficient care. Empowering the workforce is one of the most practical ways to relieve pressure on the health system. But reviews alone do not deliver reform; action does.

The government must now respond to the final report as a matter of priority. This review must not join others commissioned by the health minister that ultimately result in delay—we know this; it's a fact—inaction or simply more reviews instead of real reform. Healthcare workers and patients alike deserve clarity and progress. In closing, the opposition supports measures that responsibly improve access to health care for all Australians, particularly in rural and regional Australia, where this remains a significant challenge. We recognise the important role nurses play in our healthcare system, and the potential benefits of sensibly expanding scope of practice. At the same time, we will continue to scrutinise implementation details carefully to ensure patient safety, system efficiency and workforce sustainability are maintained.

We look forward to further clarity arising through the committee process, and to ensuring that reforms genuinely improve access to health care for Australians wherever they live. The opposition will not oppose the passage of this bill, and we will continue working to ensure Australia's healthcare system delivers timely, affordable access to health care for all Australians.

Julie-Ann Campbell (Moreton, Australian Labor Party) Share this | Link to this | Hansard source

There is a certain irony in the member for Lindsay's raising the track record of the former coalition on the matter of health. What we know about the coalition, and what we know about those opposite, is that the Liberals, the Nationals—despite the fact that there is no current coalition, they were the coalition at the time—tried to introduce a co-payment for GPs when it came to health care. This co-payment would have destroyed bulk-billing—a system that is the bedrock of ensuring that every Australian has the ability to access affordable health care—in this country.

When it comes to this bill, I want to start by talking about my family. My daughter, Margaret, the apple of both her parents' eyes, is 2½ years old now—just a touch over that. Like many babies, toddlers, children across this country, Margaret suffers from reactive airways. Basically, it means that sometimes she finds it difficult to breathe; she has issues with her respiratory system. On more than a few occasions we have taken Margaret to the hospital. And when you go to the hospital as a parent, a few things become clear: your heart starts pounding, your brow has sweat on it and your mind is racing. And when those things happen, whether you're going in an ambulance to that hospital or whether you're driving in the car up to emergency, those things are constantly on your mind.

The thing for me, when I walk into the room and a nurse comes into that room, is the relief that hits me. Nurses are the beacon of care in our community. They are the people who make sure that Australians are okay every day. Nurses are absolutely at the core of our health system with the care that they give out every single day to make sure Australians get better.

I want to acknowledge the former nurses in this place. I acknowledge the member for Cooper, Ged Kearney, for her extraordinary work not only as a nurse on the ground but also for her work in advocacy for nurses across this nation. I acknowledge the member for Bullwinkle, Trish Cook, and her fantastic work as a nurse. And I acknowledge the member for Indi, Helen Haines. We are lucky to have those nurses here with us in this place. They bring the experience of nursing onto the national stage.

In my short time giving speeches in this place, I've had the great opportunity to speak on health legislation and health related issues numerous times. The reason for this is simple: the Albanese Labor government are committed to universal health care, and we are committed to Medicare. We are committed to strengthening it. We are committed to making medicines cheaper. We are committed to expanding bulk-billing. And we are committed to making access to timely health care easier for Australians every day. Urgent care clinics—I'm delighted to say I got to visit one just last week in Oxley in my local area—and Medicare mental health centres across the country enable this seven days a week.

Today we're acting on our commitment to health with the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill. This bill builds on a strong Labor foundation of healthcare support by providing easier access to medicines. In December 2024, state and territory health ministers approved a new registration standard, which enables suitably qualified registered nurses, or RNs, to become designated RN prescribers. The Endorsement for Scheduled Medicines—Designated Registered Nurse Prescriberstandard enables this group of RNs to prescribe medicines. The standard outlines the required qualifications that an RN must have when applying to the Nursing and Midwifery Board of Australia to attain and retain the endorsement for prescribing scheduled medicines.

This bill is important because reforming the scope of practice for health practitioners means real, tangible benefits for Australians, Australians who would be able to access the affordable medicines they need when they need them. That's what this bill is all about. This bill is about affordability and accessibility, and it builds on what we, the Albanese Labor government, have already done. We've already put in place urgent care clinics, and, as we heard from ministers earlier today, there are more and more rolling out every single day. We've put in place a $25 cap on PBS medicine prices so that, when you go to the pharmacy, you will never pay more than a $20 and a $5. And we've been investing in women's health, to make sure that women's health is front and centre, with the biggest investment in women's health in the history of this country.

As the Australian College of Nursing's chief nursing officer Frances Rice said:

This increases access to care, and boosts healthcare efficiency by allowing a registered nurse to work to the top of their scope. Further, it takes pressure off nurse practitioners and medical practitioners and allows them to focus on more complex cases.

This legislation is not just about increasing access to healthcare; it's also about freeing up time and giving more efficient healthcare options across the system.

The bill amends two acts. It amends the National Health Act 1953 to enable a suitably qualified RN to be an authorised medicines prescriber. Such RNs will be able to prescribe certain medicines that are available under the Pharmaceutical Benefits Scheme. And it also amends the Health Insurance Act 1973 to enable RNs to review their prescribing services under the Professional Services Review Scheme.

Most of us might think that we have a fair idea of what registered nurses do. I assure you we don't. Unless you have been a nurse, unless you have walked those halls, whether they be in aged care or in a hospital, you don't know the demands of nursing every single day. But, if you've been to a hospital, you know that they take your vitals and that they administer your medications. You'll also find them working in residential aged-care centres, at GP clinics, in the urgent care clinics that we've been rolling out across the country, at schools and at community health centres, to name just a few locations. If you look at the scope of workplaces, it's no surprise that the job description to plan and oversee the management of people in their care includes performing treatments and complex care, and starting, administering and monitoring medication and intravenous therapy. RNs also interpret test results and reports. They participate in medical and surgical procedures and they supervise nursing students. Crucially, and perhaps much harder to quantify, patients rely on RNs to provide emotional and psychological support as they are treated. This can include advocating for those patients.

With this scope of practice—and the intense patient contact and support—it makes sense for appropriately qualified RNs to be enabled to prescribe certain medications. This will allow safe and timely and efficient prescription for patients, especially in primary-care and aged-care settings. This system has been in place in the UK since the 1990s. Nurse Charlotte Coulson, who has worked there and in Victoria in palliative care, says that RNs being enabled to prescribe medicines in palliative care cases is particularly impactful and prevents suffering, noting that 'GPs have limited time and multiple priorities'.

To qualify, RNs are required to hold current general registration, have at least three years of full-time equivalent clinical experience after becoming registered and complete a board approved postgraduate course or equivalent study in registered nurse prescribing. This comprehensive program generally takes four to six months part time and covers topics like conducting physical health assessments and the principles of safe and appropriate medical use. RNs are also trained in pharmacodynamics, which is how medications affect the body, and pharmacokinetics, which focuses on how medicines on how medicines are absorbed, distributed, metabolised and eliminated. Registration also requires six months of supervised clinical mentorship with a medical practitioner or nurse practitioner. The level of supervision is similar to nurse practitioner training and evolves from monitoring of the RN's prescribing decisions to a collaborative working relationship. One endorsed, RNs will be able to prescribe specific types of medicines. This includes schedule 3 medicines which usually require pharmacist advice but not a prescription, such as an emergency contraception. They will also be able to prescribe schedule 4 prescription only medicines such as antibiotics and medicines for high blood pressure and high cholesterol.

The reform in this bill aligns with the intent of the Strengthening Medicare Taskforce and the October 2024 Unleashing the potential of our health workforcescope of practice review. The aim of that review was to, 'reform our primary care workforce to deliver high quality, equitable, integrated and sustainable healthcare for Australian communities'. This built on the extensive work of and consultations by the Nursing and Midwifery Board of Australia and Australian Chief Nursing and Midwifery Officer since 2017 around the potential for RNs to increase their scope of practice. The registration standard was developed after comprehensive consultation with numerous peak bodies, including the Royal Australian College of General Practitioners, the AMA, the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives and the Australian Primary Healthcare Nurses Association.

The reforms in this bill are part of a bigger picture for the Albanese government. It is a picture of the Albanese Labor government's investment in public health. In 2023 Labor increased the bulk-billing incentive threefold for groups who rely on their GP the most. The Albanese Labor government increased that bulk-billing incentive for pensioners, for concession card holders and for families with children, and this change reversed the decline in bulk-billing and resulted in an extra 6.5 million bulk-billed GP appointments across the country.

A major milestone for Medicare then took effect on 1 November last year. From that date, for the first time, GPs received the bulk-billing incentive for every patient they bulk-billed, not just the groups I just mentioned. This is the largest single investment ever made in Medicare and is expected to support around 18 million additional bulk-billed visits every single year. In my electorate of Moreton, there are now 20 bulk-billed GP clinics, with 10 clinics moving from a mixed model to a full bulk-billing model. This is a 50 per cent increase, and it means that people on the south side of Brisbane have more access than ever before to bulk-billed GP clinics. With these reforms, projections show that by 2030 around 90 per cent of GP visits nationwide will be bulk-billed, and it also means that the number of fully bulk-billing practices is set to grow to roughly 4,800 clinics. That's more than three times the current figure, which is a significant improvement for communities across Australia.

Urgent care clinics are also easing demand on hospital emergency departments. In Oxley in my own electorate of Moreton the local clinic is already making a difference. It's the health professionals there who are treating over 12,200 patients as of mid-January, and it's the same with expanding networks across the country. I note the member for Griffith is in the chamber tonight. We have one right on our border which also helps so many people in Annerley. In the 2025 budget the government committed nearly $645 million over three years to expand the number of urgent care clinics from 87 to 137, and as a result four out five Australians live within a 20-minute drive of free, high quality, urgent medical care, something that could only be achieved under this Labor government. And from 1 January, as I said before, the maximum co-payment for a standard PBS subscription fell from $31.60 to $25.

Labor's commitment to health care is underpinned by our fundamental values. It's part of who we are. It's part of what runs through our blood. It's part of our DNA. We haven't held these values for a minute; we've held them for a very long time. The Australian Labor Party believes that everyone deserves access to health care, regardless of your income, regardless of your employment and regardless of where you live.

Helen Haines (Indi, Independent) Share this | Link to this | Hansard source

I rise to make a brief contribution on the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025. I acknowledge the member for Moreton, who's given us such an elegant explanation of what this bill is about, what this bill aims to do and what I feel very confident this bill will achieve. I thank her for her acknowledgement of nurses right across Australia, many of whom are old former colleagues of mine, and I thank her for her very clear recognition and understanding of the work that nurses do.

This bill amends the National Health Act 1953 and the Health Insurance Act 1973 to allow authorised registered nurses to prescribe medications under the Pharmaceutical Benefits Scheme. In doing so, it adds the final piece to an important reform that's been under development for almost a decade. This isn't a flash in the pan. This isn't something that someone's just come up with. This has been a long time in development, and that's because it's important to get these things right.

I highlight that this is about authorised registered nurses. This is about nurses who have undertaken significant further education and training to enable them to expand their scope of practice now to prescribe a formulary of medications. The introduction of registered nurse prescribing is the result of extensive coordination and collaboration between the Nursing and Midwifery Board of Australia, the Australian Health Practitioner Regulation Agency, the Australian and New Zealand Council of Chief Nursing and Midwifery Officers and the health ministers across all Australian jurisdictions.

The member for Moreton laid out the extensive training that's required in order for authorised nurses to prescribe schedule 3 and 4 medications, and made it quite clear that this is part of a bigger suite of reforms to strengthen Medicare. I was involved many years ago, in Australia, in the very beginning of nurse practitioner education and training. It was part of my role, leading the education of a cohort of 14 aspirant nurse practitioners in a rural and regional health service to assist them with their education and training in pharmacology and other elements of the higher training they required in order to meet the scope of practice that was critical to becoming an endorsed nurse practitioner. I've spent more than three decades working in health care, and one of the most extraordinary evolutions I've seen is how nurses' scope of practice, and, indeed, other health professionals—allied health, too—has grown over the last decade to respond to the growing requirements of our population, particularly our ageing population.

This initiative, just like the nurse practitioner pioneers, is especially important to me as a regional MP and as a former nurse and midwife. I know, because I've seen it and lived it, that regional, rural and remote Australians—and you know it, Deputy Speaker Scrymgour—have a higher burden of disease than our metropolitan counterparts. We know that our health care is dictated by our postcode, and in my electorate of Indi—which is a regional electorate, but it has some remote areas too—we experience conditions such as asthma, arthritis and heart disease at rates way above the national average. This piece of legislation enables fully authorised and educated nurses to prescribe medications in categories that will absolutely make a difference to timely care in these chronic diseases.

This bill is really important to me because I can give confidence to anybody in this House that this will make a difference to people who suffer from chronic disease, most particularly in rural and regional Australia. When I talk about chronic diseases being above the national rate and rural, regional and remote Australians dying earlier than their metropolitan counterparts, I do that knowing many of the people who have, in fact, died prematurely because they simply had not had access to the care that they needed. To make matters worse, we have healthcare workforce shortages in the regions that make it practically harder to effectively manage chronic health conditions and illnesses.

Now, while this bill doesn't directly address the issue of healthcare workforce supply, I do want to spend a little moment talking about this, because it is part of the broader picture. It's really important that we situate this legislation in the broader reality of health care in the regions. Of course, this legislation isn't restricted to nurses who work in the regions—it's across Australia—but I'm highlighting why it matters to communities like mine in particular. Regional communities absolutely struggle to access healthcare, including the prescribing of medications. To be clear, I want to say that the healthcare workforce in regional Australia is absolutely fantastic, filled with highly competent professionals, of whom the biggest group are nurses, and so many of them had not been able until more recent times to work to their full scope of practice. These problems aren't their doing. There's simply not enough workforce to meet our healthcare demands. So, with the workforce that we have, we need to ensure absolutely that we're providing the opportunities to access the training and education they need to expand their scope of practice and work closely with the people who need them most.

Further to that, when I think about health workforce in rural and regional Australia, it's not just a matter of attracting workforce; it's also a matter of retaining them. One of the challenges for many nurses is job satisfaction—the frustration of seeing a patient who needs further care and the restrictions on nurses in being able to provide that care. That's why this bill, again, is really important in a sense of expanding scope of practice and really building on job satisfaction for a nurse.

The reasons for workforce shortages in rural health are many and complex. Certainly there is inadequate resourcing of regional health systems. Training pathways make getting regional experience difficult or unaffordable. Housing and childcare shortages prevent talented professionals from moving to regional Australia. We really do have a wicked problem, and there isn't just one policy to solve it, but this piece of legislation is part of that puzzle, and I really welcome it. The truth is that, if we're going to address workforce challenges, we do need to come at it from all angles, and that includes making sure that every single healthcare professional is supported to work at their full scope of practice. This bill supports a reform that does precisely this.

In Victoria, the number of nurses is actually relatively consistent in proportion to population across major cities, inner and outer regions and remote communities. In fact, as I said before, nurses make up the highest number of healthcare professionals in the bush, and, where we do have the workforce in rural and regional Australia, we need to make sure that we're not putting unnecessary handbrakes on the care that they can provide their communities. I've been in that situation many times in my long distant past, working in a bush nursing hospital where I have waited on the phone, trying to get on to a medical practitioner to come and prescribe what is a pretty basic repeat medication for a patient who's driven for several hours to come to the hospital to get that medication. It all could have been sorted in a very short time if a nurse had this additional capacity. Enabling registered nurses to expand their scope of practice through additional training endorsement—really, it's a commonsense national solution and one I hope will materially improve access to health care in the regions. We've heard this evening that this isn't Robinson Crusoe; this is happening in many other parts of the world, most recognisably in the United Kingdom.

Right now there are people in my electorate of Indi who spend half a day travelling or wait weeks for GP appointments just to get that repeat prescription, and I'm hoping this legislation is going to be a godsend for them. It'll make a real difference to their lives if they can get their medications a little sooner and a little closer to home. I'm absolutely alive to concerns from some other members of the health team about fragmented care. I'm the first to say that we really must make sure that our communication and digital tools are sufficient to enable us to ensure that we do not have fragmentation.

Debate interrupted.