Jordon Steele-John (WA, Australian Greens) | Link to this | Hansard source

I am pleased to continue speaking to the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025. Nurse prescribers have been pushing for this for a very long time—to be able to work to their full scope of practice and support patients to access faster, more affordable quality health care. The Greens are pleased to support this bill.

Nurse prescribing will allow for greater efficiency in the healthcare system, as many patients will only need to visit a single point of care. Fewer referrals and hospital admissions will bring down the cost of treatment for many patients, which will lower the cost barriers to accessing health care during this cost-of-living crisis. To get the full benefits of this change, nurse prescribing needs to be implemented not only in hospitals but also in primary healthcare settings, such as local clinics and aged-care settings. This bill went before a Senate inquiry and was supported by the Australian Primary Health Care Nurses Association and the Australian Nursing and Midwifery Federation, among many others.

Some submissions to the inquiry raised concerns about ensuring that nurse prescribing is implemented in a way that upholds the highest standards of patient safety. The Greens are firmly committed to making sure that people feel safe, supported and confident when accessing health care, regardless of who is providing that care. I am pleased that this bill introduces a number of important safeguarding measures, including the requirement for nurse prescribers to be in a prescribing agreement with existing prescribers and to complete a six-month clinical mentorship process with an authorised health practitioner; additional training and qualification requirements beyond those needed to be a registered nurse; the ability for the minister to designate which medicines can and can't be prescribed by nurse prescribers; and the expansion of the Professional Services Review, ensuring appropriate oversight of nurses in their role as PBS prescribers. Additionally, I understand that further safeguarding measures will be detailed in the delegated legislation. With these details that are in development, as they are in development, the Greens will be playing a careful, scrutinising role to ensure that patient safety remains at the centre of reform.

While we are discussing healthcare professionals working safely within their scope of practice, it is important to recognise that many submissions to the Senate inquiry identified opportunities to go further. More than 20 submissions highlighted a clear and practical reform—expanding access to PBS subsidised prescribing for additional qualified health practitioners. One of those professions is podiatrists and podiatric surgeons. I have had the pleasure of meeting with podiatric surgeons and representatives at the University of Western Australia's Podiatry Clinic, and their message was clear: podiatrists and podiatric surgeons are already endorsed prescribers. They are fully qualified and authorised to prescribe medicines. However, they cannot access the PBS for PBS subsidies for those prescriptions. This means their patients are left paying full price for medicines that would otherwise be subsidised. As the Australian Podiatry Association noted in its submission:

… a podiatrist with an endorsement to prescribe medicines may clinically decide a medicine is needed today, yet the patient must still book a second consult … just to obtain a PBS-subsidised script.

This is not just inefficient; it creates barriers to care.

We have a clear example provided to us from the Advanced Practicing Podiatrists High Risk Foot Group. A 72-year-old man on the age pension living with diabetes attends the podiatry clinic for his annual foot health review under an enhanced primary care referral. During the consultation, the podiatrist identifies a probable fungal infection and recommends a standard 12-week course of oral antifungal medications. The podiatrist is qualified to prescribe and can initiate treatment immediately, but, because the prescription is not covered by the PBS, the patient must pay out of pocket. At a discount chemist, this would be $27.99. He is left with a choice: pay out of pocket or book for an additional GP appointment just to access a subsidised script. This is unnecessary. It wastes time and it increases costs for patients and for the system. It reflects rules that have not kept pace with how people actually access health care.

We have an opportunity to fix this. The Australian Greens are calling on the government to update the law to allow podiatrists and podiatric surgeons to access PBS benefits when prescribing within their scope of practice. This is a practical reform that would make health care more affordable, more timely and more patient centred. The Greens call on the government to make this change, and I foreshadow that I will move the second reading amendment in my name to give effect to it.

In conclusion, allowing registered nurses to prescribe PBS medicines within their scope of practice will expand choice, improve access and reduce pressure on other parts of the healthcare system. The scope-of-practice review recommended this change, along with many other pathways to enable non-medical practitioners to play a greater role in the provision of safe, quality health care. The Greens encourage the Labor government to go further in their response to the scope-of-practice review and to implement the identified opportunities for ensuring more healthcare professionals can work to the top of their scope of practice. Getting this work done helps everybody in the system. It's complicated. It's detailed. It's often behind the scenes, but it is the work that, when achieved, delivers better care for people—more affordable care for people.

In the time that I've had the health portfolio for the Greens, I have had the opportunity to learn from many experts—treating clinicians, allied health professionals, general practitioners and so many others—and the common thread between them all is a desire to work with government to get good health outcomes for people and to reform the system so that it works. It's the responsibility of elected officials to be up for the hard and complicated work to get that done. It's sometimes not glamourous, but, when it is ultimately resolved, it makes a real difference in people's lives. I look forward to continuing to work across the chamber to advance the implementation of the scope of practice review and to bring down healthcare costs in the Australian community.

Wendy Askew (Tasmania, Liberal Party) | Link to this | Hansard source

I rise to speak on the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025. As a senator for Tasmania, I'm acutely aware of the profound and persistent challenges facing Australia's healthcare system. Nowhere are those challenges felt more clearly than in my home state. Tasmania is, in many respects, a microcosm of the pressures confronting health care nationally. We have the oldest population in the country, we have higher rates of chronic disease and socioeconomic disadvantage, and we are a regional and dispersed state where geography and limited transport options continue to create real barriers to care. Taken together, these factors have produced a perfect storm for a healthcare system that is struggling not only to meet demand but to recruit and retain the skilled workforce required to deliver high-quality, timely care.

For Tasmanians, difficulty in accessing health care is not an occasional inconvenience; it is routine. Access to general practitioners, particularly in regional and rural communities, is increasingly limited. Emergency departments are under sustained pressure, and hospital flow is routinely constrained. Too often, patients who are well enough to leave hospital remain stuck in beds, not because they require acute care but because there are insufficient aged-care or disability placements available to safely discharge them. This has a ripple effect across the entire system, reducing capacity and increasing delays for others who need care.

Behind these patient-facing challenges sits a workforce crisis. Tasmania, like many jurisdictions, relies heavily on interstate and overseas locums to fill critical gaps. While those clinicians play an important role, this reliance comes at a significant and unsustainable financial cost, further straining already stretched health budgets. All of these pressures persist despite increased investment from the Tasmanian Liberal government and additional funding from the Commonwealth. That reality demonstrates a crucial point: simply spending more money without meaningful reform will not fix a system under structural stress.

Tasmania shows us plainly that the challenges facing health care are national in nature and that the responsibility for reform must sit here in Canberra. It cannot be left solely to the states and territories to absorb growing demand, workforce shortages and outdated models of care.

The coalition supports the intent of this bill. Expanding prescribing capabilities to registered nurses has the potential to improve access to medicines and make better use of the skills already within our health workforce, particularly in regional, rural and remote areas. However, the government's narrow approach means significant pressure points remain embedded in the system. By limiting this expansion to registered nurses alone and excluding other suitably qualified health professionals such as podiatrists, Labor has missed an opportunity for more comprehensive reform. Reducing the burden on our healthcare system will not occur through a single policy lever. The coalition agrees that we must start somewhere. We support taking prudent first steps, but we are clear eyed that this legislation on its own will not deliver the systemic change required to address workforce shortages or growing patient demand.

I am a member of the Community Affairs Legislation Committee, which recently inquired into this bill. We received compelling evidence from a wide range of stakeholders supporting the inclusion of registered nurses as PBS prescribers. The Australian Medical Association, the Australian Nursing and Midwifery Federation, private health insurers such as Bupa, and other clinical experts all spoke to the benefits this change could deliver for patients. That evidence should be acknowledged. However, my coalition colleagues and I remain disappointed that the government has failed to present a coherent whole-of-system plan to improve access to PBS subsidised medicines across the board. More than 20 submissions to the inquiry specifically called for podiatrists to be included in the expansion of prescribing powers, yet under this legislation podiatrists and podiatric surgeons will remain the only nationally endorsed health practitioners whose patients cannot access PBS subsidised medicines from their treating clinicians. This outcome underscores the ad hoc nature of Labor's approach.

These reforms stem from the Unleashing the Potential of our Health Workforce—Scope of Practice Review, a review commissioned and completed some 18 months ago. Despite its significance, stakeholders are still waiting for the government's formal response. Disturbingly, Senate estimates recently revealed that the government has not even committed to delivering a response at all. That uncertainty leaves health professionals, service providers and patients without clarity, direction or confidence in Labor's long-term intent. While this bill will deliver some benefits, it falls well short of what is required to address rising demand, workforce shortages and access inequities across the country. Expanding prescribing powers for nurses is a step forward, but it does not and cannot resolve the systemic issues that are crippling the sector.

Australia's healthcare system is under significant strain. Addressing that strain will require bold, coordinated and comprehensive reform. This bill should be the first step, not the final word. The coalition, with patients and the broader health sector, will continue to call on the government to provide a comprehensive response to the scope-of-practice review—one that clearly outlines its position on each recommendation and provides an indicative timeline for action. Such transparency would offer much needed certainty to stakeholders and demonstrate a genuine commitment to improving health outcomes for all Australians.

Charlotte Walker (SA, Australian Labor Party) | Link to this | Hansard source

Australians don't spend much time thinking about who's allowed to prescribe a medicine; they think about whether they can get an appointment, whether they have to drive two hours to see a doctor, whether Mum can get the medication she needs before the weekend or whether Dad can leave hospital without another delay. That's what the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025 is about. It's about making our health system work better for the people who rely on it every single day.

For too many Australians, particularly those living in regional, rural and remote communities, getting timely health care isn't as simple as booking an appointment down the road. Sometimes there isn't a GP down the road. Sometimes the nearest clinic is hours away. And sometimes your local nurse is the health professional you know, you trust and you see most regularly. If that nurse has the qualifications, the training and the appropriate endorsement, why should patients have to jump through another hoop just to access a medicine they're already taking? This bill recognises that common sense. It allows suitably qualified registered nurses to prescribe certain medications under the Pharmaceutical Benefits Scheme, helping patients get the care they need sooner without compromising safety.

This bill isn't about replacing doctors or lowering standards; it's about making better use of the incredible workforce we already have. Anyone who has spent time in a hospital, an aged-care home, an Aboriginal community controlled health organisation or a regional health clinic knows just how much nurses already do. They're often the first person a patient sees, the last person they see before going home and the one constant throughout their care. They know their patients. They know their communities. They are the backbone of the healthcare industry. And they know when something isn't quite right. This reform simply recognises the expertise they already bring to our health system. For someone in a country town, it could mean getting treatment without waiting days for the next available GP appointment.

Glenn Sterle (WA, Australian Labor Party) | Link to this | Hansard source

Order! Sorry, Senator Walker. It being 1.30 pm, we shall now move to two-minute statements.