Mr McEACHAN (Redlands—LNP) (5.12 pm): I rise to contribute to the debate on the Public Health (Water Risk Management) Amendment Bill 2016. I want to begin by thanking the committee secretariat for its hard work on this report along with that of the chair, the member for Kallangur, the deputy chair, the member for Southport, and my fellow committee members. I also want to acknowledge those members who contributed to this report under the previous committee prior to 18 February 2016.
The report handed down by this committee recommends that the bill be passed and recommends that the Minister for Health and Minister for Ambulance Services clarify in his second reading speech the meaning of the term ‘person in charge’ and also investigate options for including a precise definition of ‘person in charge’ in whatever legislation is considered most appropriate, and I understand that the minister has already addressed that issue. In making the recommendations, I understand the committee’s consultation had been limited due to the urgency of the proposed amendments. Key private healthcare providers and representatives for smaller healthcare providers and all hospital and health service chief executives have been notified of the proposed legislation. Consultation with the private residential aged-care sector will be undertaken during a phased implementation process.
I now turn to the amendments proposed to the Public Health Act 2005. These amendments work to achieve the objectives of the bill which are to improve the management and control of health risks associated with the supply and use of water in hospitals and residential care facilities, in particular the health risks associated with legionella bacteria, and provide greater transparency of water testing activities being undertaken by these facilities. Proposed new section 61D sets out what the water risk management plan must contain and provides for additional requirements to be prescribed by regulation. The committee received submissions with regard to the implementation of a water risk management plan. In particular, the Central Queensland Hospital and Health Service raised concerns that the implementation of the bill’s proposed amendments will incur considerable costs for healthcare facilities and that there is no funding or resources being provided for this purpose. As a result of this, the committee requested further details on the implementation costs.
The department advised the committee that the cost for facilities to implement interim measures that already have water risk management plans in place are not expected to be significant. Funding will have to be set aside to implement remedial measures should legionella or other hazards be detected in the facility’s water supply system. The department advised that estimated costs associated with expanding existing water risk management plans would range from zero to over $100,000 and that, similarly, the costs associated with infrastructure improvements will also vary based on factors such as the age of the facility and incoming water quality, potentially costing several hundred thousand into the millions of dollars. The department advised that the cost for state government facilities would be incurred over a period of years in line with existing infrastructure budgets. The department also advised that budgeting arrangements for licensed private health facilities are unknown and that other costs to government such as compliance, enforcement and the provision of training will be funded within existing departmental budget allocations.
In considering proposed new section 61A of the bill, the committee took submissions from the Metro South Hospital and Health Service and Central Queensland Hospital and Health Service as to the definition of a prescribed facility. The Metro South Hospital and Health Service questioned the definition of a prescribed facility and its application to public sector mental health community care units. Residents in these facilities are not classified as inpatients and are not aged-care residents, so the department clarified that the intention of the bill was that it would not apply to these units as they are not hospitals as defined by the Hospital and Health Boards Act.
The committee also considered the requirement under proposed new section 61K of the bill which proposes that the chief executive of the department publish a report, with notices given by facilities about the presence of legionella or reports about prescribed tests undertaken in accordance with water risk management plans. It was a point of some discussion for the committee on how public reporting of the presence of legionella might be received by the public, and I refer to the report in relation to that issue. The report states—
... while there are over 50 species of Legionella, the species of most concern in drinking water in a health care facility is Legionella pneumophia serogroup 1.
The Department acknowledged certain species of Legionella present a greater health risk than others, however, it explained: the conditions that allow low risk Legionella species to proliferate are the same conditions that allow for the more dangerous species to proliferate. Therefore, for the purposes of identifying hazards in a water risk management plan, and in relation to the notification and reporting requirements, the Bill doesn’t differentiate between different types of Legionella bacteria.
The report states—The CQHH— the Central Queensland Hospital and Health Service— raises a concern that the Bill does not disclose which tests would be included in the definition of a prescribed test for Legionella. It states that there are different types of tests for Legionella and some laboratories can perform more sensitive tests than others. The CQHHS is concerned that this could place facilities that use these laboratories at a disadvantage and notes section 61H(1) also refers to the use of a prescribed test.
In response to a question taken on notice at the public briefing the department advised—
... tests for Legionella in water can be divided into two categories: DNA-based tests and culture-based tests. DNA-based tests can provide very quick results, however, they don’t provide information on whether any Legionella detected is alive or dead. As a consequence, the results from DNA-based tests provide only limited information with regards to how hazardous the water is to human health. Culture-based tests, on the other hand, provide results in terms of ‘culturable’ Legionella. These are live Legionella cells and provide more useful information with regards to how hazardous the water is. For these reasons, it is the Department’s intention to prescribe certain culture-based tests in the Regulation. Specifically, it is intended to reference the methodologies prescribed in Australian Standard AS3896 and international standard IS011731.
The bill proposes a requirement that the chief executive of the department publish in a report notices given by facilities about the presence of legionella or reports about prescribed tests for legionella undertaken in accordance with water risk management plans. The CQHHS submission raised the concern that I mentioned earlier. In its submission, it stated that public reporting of legionella test results may not be in the best interest of healthcare facilities nor the public as it may result in unjustified levels of concern and anxiety and undermine confidence in a facility. The department responded by stating that it does not intend to make any revisions to the bill in response to that issue and that the inclusion of provisions allowing for the publication of legionella test results fulfils the government’s commitment to greater public transparency.
At our public briefing, the department responded to a question from the committee on the likely risks or concerns that may be associated with public reporting. The departmental officer said—
I do not believe there are any risks. I am certain that people are concerned about it because they are concerned that people will find out information about their facility that they might prefer that people not know about, but I think it is very important and I think the public values knowledge. The more we get the information out there, the more it becomes understood. It is not necessarily that a facility has done anything wrong by having legionella in their water supply. It is ubiquitous; it is everywhere. The problem is how they respond to that. If facilities have to have that information out there publicly, then the community I think will have greater confidence in the services that are being provided to them.
I think that is an important point. That is one aspect of this bill and its implementation that we need to watch closely in order to monitor the impacts on facilities that publicly report incidents of legionella. A representative of the plumbers union also provided evidence. He said—
I have worked in this industry for roughly seven years, and I do not think I have gone a week without someone raising this— legionella— as an issue. It is something that everybody talks about, and unfortunately it is also subject to the rumour mill within the community. That is why we think it is really fantastic that there will be public reporting of this. There is no doubt in my mind—and there is no doubt in the minds of the people I talk to in our industry—that the lack of knowledge within the public on this matter is currently eroding public confidence and patient confidence in the system, so we think it is really fantastic that it is being addressed and that people will get a fair bit of knowledge, certainty and confidence in this area.
It was some comfort to the committee to hear both of those opinions. The other aspect that the committee heard was in relation to ice machines and warm water systems and, as the good member for Southport mentioned earlier, thermostatic mixing valves.
Mr McArdle interjected.
Mr McEACHAN: Thermostatic mixing valves. We asked the plumbers union to bring one in so that we could have a look. We have seen a thermostatic mixing valve. They are real. In their submissions the plumbers union of Queensland and the Master Plumbers’ Association of Queensland highlight the role that industry standards play in relation to the design, operation and maintenance of ice machines, warm water systems and TMVs—thermostatic mixing valves.
An opposition member interjected.
Mr McEACHAN: I should have brought one in. For example, in terms of the quality of ice machines, in its submission the MPAQ explained—
... many machines do not meet certification standards, Water Mark approval as required by the National Construction Code Volume 3, the Plumbing Code of Australia, and this is a matter that must be rectified.
The plumbers union of Queensland and the MPAQ support an amendment to the bill to reference the need to comply with existing industry standards. In response, the department advised that the ‘potential for these industry standards to be called up in legislation would be most appropriately considered by the Department of Housing and Public Works’.
In response to a question on this issue at the public briefing, the department confirmed that it will be alerting that department to the necessity for reviewing these amendments. Regarding the quality of ice machines, the department clarified that it has a policy in place that requires ice machines in health facilities to comply with the industry standard water mark approval. However, that leaves open the prospect that there are many ice machines out in the community that do not meet this industry standard.
Mr Power: Including here in the parliament.
Mr McEACHAN: Quite possibly in the parliament. I thank the member for Logan. In its submission the plumbers union of Queensland highlighted the need to employ licensed persons to install and maintain the infrastructure related to legionella. It also raised this issue at the hearing. The representative from the plumbers union said—
We are aware that the Queensland Building and Construction Commission are currently undertaking a licensing review. We think that this is a big part of what needs to occur in that review and what the outcomes need to be.
As we stated in our submission, we consider that for far too long the prevention, detection and rectification work associated with legionella has been addressed in a suboptimal way. Addressing such a harmful presence through non-skilled labour, a lack of regular checks and generally poor practices has increased the likelihood of additional issues, in our opinion. Licensed persons must be involved in the installation and maintenance of all infrastructure related to legionella, including cooling water systems, air-handling systems and their associated duct work and pipework. They have been identified as particular areas where legionella is commonly found.
The report goes on to refer to one of the aspects that the committee covered, which was the right to enter dwellings and residential aged-care facilities in the case where legionella was detected. Under clauses 5 and 6, which relate to the power to enter premises, the bill proposes to amend section 385(1)(d) of the Public Health Act to add new sections 389A and 389B to the list of sections under authority by which an authorised person may enter a place. Clause also amends section 385(3), which currently limits section 385 search powers by stating—
... nothing in this part allows entry to a dwelling without the occupier’s consent, an enforcement order or a warrant. The amendment proposed by clause 5 confirms section 389B as an exception to that general rule, as section 389B does provide for a power to enter dwellings in residential aged care facilities in certain circumstances, even without the occupier’s consent, an enforcement order or warrant.
Clause 6 of the bill proposes to insert new sections 389A and 389B into the Public Health Act to confer a general power to enter a prescribed facility and a power to enter dwellings in residential aged- care facilities. Proposed new section 389B(2) applies where someone at a residential aged-care facility has had a notifiable condition resulting from legionella or where the result of a prescribed test confirms the presence of legionella in water used by the prescribed facility. It allows for an unauthorised person to enter a part of the residential aged-care facility that is an occupier’s dwelling for monitoring compliance with the facility’s water risk management plan without requiring the occupier’s consent, an enforcement order or a warrant.
The committee noted that the power to enter dwellings in a residential aged-care facility is only triggered when someone at a residential aged-care facility has had a notifiable condition resulting from legionella or where the result of the prescribed test confirms the presence of legionella in water used by a prescribed facility. When those preconditions are met, the entry powers become exercisable under subsection (2), but there are a number of safeguards on the exercise of that power contained in subsections (3) and (4). Given the limited circumstances in which the powers become exercisable and the statutory safeguards on the manner in which the powers may be exercised, the committee is satisfied that the entry powers are appropriate to the circumstances.
The committee also notes the response provided by the Department of Health regarding the definitions and how ‘person in charge of a prescribed facility’ differs from ‘responsible person’. The committee is concerned that, given the proposed offences will apply to either a responsible person or a person in charge, the definitions of both these terms could be easily interchangeable. I referred to that earlier and the minister has addressed that in his second reading speech.
In closing, the bill is proactively taking on legionnaire’s. It minimises the risk of outbreaks before they occur and has the capacity to maintain public confidence in our health and aged-care system. I acknowledge and share the concerns raised by my colleagues in relation to the costs involved in implementing these management plans. I note particular concerns raised about the costs in rural and regional facilities. I urge the Palaszczuk Labor government to be considered in its approach to dealing with rural and regional facilities facing significant cost burdens. I commend the bill to the House.