General Purpose Standing Committee No. 2

Debate resumed from 21 October 2008.

The Hon. ROBYN PARKER [2.30 p.m.]: I speak as the Chair of General Purpose Standing Committee No. 2 in relation to the inquiry into the management and operations of the Ambulance Service of New South Wales. I say at the outset that the report is worth reading, and members who have not yet picked up a copy of it should do so. We do not have the Government response yet, and members need to be familiar with the report's contents to see how well the Government responds to a number of the issues raised. The Ambulance Service of New South Wales has been under the spotlight numerous times over the past decade and, as a result, there have been various reviews and inquiries into the operational aspects of the service. There have been many inquiries; however, none of the reviews focussed on the key issues that were brought to light during this inquiry—namely, the service's management and culture and, in particular, the occurrence of bullying and harassment within the organisation.

This inquiry was undertaken because of an overwhelming level of concern raised with members of Parliament and the media by ambulance officers, staff and community members. The establishment of the inquiry had broad-ranging support. That support was due to a range of factors but primarily because the terms of reference addressed specifically the bullying and harassment issues, and the inquiry was to be conducted by a committee that was seen not to be controlled by the Government. A great deal of faith, evidenced by the large number of submissions, was placed in the committee to come up with recommendations that were strong and unambiguous. As the chair of the committee I feel that that faith was well placed. The committee was distressed to hear about the depths of despair experienced by some paramedics as a result of bullying and harassment by their colleagues and managers, which in numerous cases had contributed to depression, anxiety, self-harm and, sadly, suicide.

Of significant concern is the way management handled, or indeed failed to handle, these matters over the years. The drawn-out process of grievance and complaints handling within the service has exacerbated many of these situations, which has resulted in some becoming almost irreconcilable. The fragile psychological state demonstrated by some participants during the inquiry prompted the committee to establish a mental health support plan, in consultation with an independent clinical psychologist, to offer appropriate support to some of the more aggrieved participants. This was a groundbreaking but absolutely vital move. So poor was the trust in the management and the Department of Health by many of the witnesses that the independence of this process was paramount.

The committee has suggested that further investigation into establishing plans such as this be undertaken to establish protocols that other committees may adopt in future inquiries. I thank Stephen Reynolds for his dedication, considered advice and contribution to this process, along with Beverley Duffy, the committee director, and other secretariat staff. The committee was supported throughout this inquiry by a secretariat of outstanding quality. I have already mentioned the leadership of committee director Beverley Duffy. The team of Teresa Robinson, Sam Griffith, Cathryn Cummins, Christine Nguyen and Merrin Thompson dealt with the witnesses in a highly professional manner at all times. This was an extraordinary inquiry in so many ways, and on behalf of the committee I thank the entire committee staff for their dedication.

We should be proud of our staff in this Parliament. We are undertaking a number of training programs with other nations, particularly Pacific nations. I am proud of the level of support we receive from our staff and the way they resource members of Parliament so well, so professionally and in an unbiased way. They then pass on their skills to other parliaments. While it is clear that paramedics love their work, the joy of helping people and saving lives has been clouded by the indifference of some ambulance managers towards their employees and their inability to foster a safe and healthy work environment. This has resulted in high levels of unresolved conflict within the service and a level of morale so low that it appeared that it could not get any worse.

There are extremely serious cultural problems within the Ambulance Service. This was demonstrated by the fact that the majority of the authors of the 261 submissions received by the committee requested that their submissions remain confidential or partially confidential for fear of negative repercussions from management should their participation in the inquiry be revealed. The performance of the senior executive team, particularly that of the current chief executive, was criticised by a substantial number of inquiry participants, who further condemned the nepotistic old-boys club culture that pervades the organisation. This report makes a number of key recommendations designed to address these issues and to shift the focus of management from budgets and performance indicators to its key asset—its people.

The committee has made recommendations to strengthen accountability within the service, and has emphasised that it is the responsibility of the Minister for Health and the Director General of New South Wales Health to ensure that the service's senior executives are completely fulfilling their duties. While many inquiry participants acknowledged that stress was part of the job, they suggested that management was largely responsible for creating a difficult working environment. The committee was told that some managers are inept and uncaring, that staff and Ambulance Service problems are ignored and that more focus is placed on budgets and performance indicators than employees. A significant number of managers have been appointed to their positions more because of their length of service rather than their ability to manage people. This is one of the key factors contributing to the service's problems.

The service and the Government have known about the way in which ambulance officers are managed and how unhappy these officers have been about their workplaces for many years—at least eight years—through Auditor-General reports, culture and attrition surveys and the Performance Review of the Ambulance Service of New South Wales. The chief executive of the service has failed to implement much-needed reforms to solve fundamental cultural and management problems, although he has been aware of these problems for nearly a decade. The inaction of the senior executive team has also played a significant role in the state of the service's affairs. The Minister for Health and the Director General of New South Wales Health have a key role to play in ensuring that the Ambulance Service fulfils its duties. I look forward to their response to our recommendations, which should be received by the end of April at the latest.

One of the committee's key recommendations is that the Minister and the director general meet with the chief executive on a regular basis to review the chief executive's position and to report back to Parliament, as well as that all senior executive managers undergo rigorous performance assessments. The incidence and mismanagement of bullying and harassment were a major impetus for this inquiry. The committee was distressed by the evidence regarding the level of bullying and harassment that has been allowed to persist within the Ambulance Service. Major changes must occur as a matter of urgency to address these serious concerns. I must add that there are still concerns. As the committee chair I am still receiving calls—other committee members may also be receiving them—from distressed ambulance officers some months after the inquiry concluded. People are more likely to behave inappropriately towards each other if they are under stress.

Improving ambulance officers' working conditions is critical to reducing the level of bullying and harassment within the service. Management at all levels in the service needs to take responsibility for these problems. Significant concerns were raised regarding the professional standards and conduct unit, which ambulance officers perceive to be biased and unaccountable. The committee has therefore recommended that an independent process be established to enable the Ambulance Service staff to appeal against decisions by the unit. Evidence was provided to the committee not only of suicides but also of officers who had attempted, or were contemplating, suicide. Many thought that support services were not encouraged properly by managers due to inadequate staffing or a lack of skills and managers to deal with such situations. A common theme among most submissions to this inquiry was that of inadequate staff levels, dissatisfaction with pay rates and outdated and inflexible award conditions.

I note that simultaneous with this committee's inquiry, a case was being heard in the Industrial Relations Commission for better pay and conditions—something that is reflected in the final report. Many participants in the inquiry, particularly the Health Services Union, demanded that the head of the service should be a uniformed commissioner. Whilst that has been promoted as a solution to the problems in the service, the committee maintains that it will not change the culture of the service. In fact, it may further entrench the damaging boys-club culture that exists today. The effective management of the service is dependent upon the individual who fills the leadership position rather than on whether they wear a uniform. However, it is critical that the head of the service is held accountable for their decisions and performance, and the committee has made a number of recommendations to facilitate that.

The committee has recommended that, in addition to the Minister for Health and the Director General of New South Wales Health regularly reviewing the performance of the chief executive officer, particular focus be given to reviewing the progress in reducing bullying and harassment in the service, which is essential to ensure that psychological distress experienced by ambulance officers who have been subjected to this behaviour is addressed. To further improve accountability, the committee also made key recommendations to establish a direct reporting line to the Minister for Health and to create a new board of directors to provide checks and balances on executive decisions.

Overall, these recommendations are designed to ensure that the Ambulance Service has an executive that recognises the value of its people, listens to its employees and is held accountable for its actions and inactions. The Minister for Health has a key role in ensuring that those duties are fulfilled and the responsibilities are met. New South Wales is the only jurisdiction in Australia without its own ambulance Act. The committee has recommended changes so that the current deficient, confusing and outdated regulations are amended. The committee recommends establishing a new Ambulance Service Act for New South Wales to enshrine many of the recommendation it has made throughout the report.

The committee expects the Government to take immediate and decisive action. In fact, I wonder why it has not taken action sooner rather than waiting for the full six months in response to the committee's recommendations, starting with senior management, to bring about cultural change. The committee is not prepared to have this report swept under the rug. For that reason, in October 2009 the committee will institute a review of the recommendations contained in this report when we will focus on the service's progress in breaking down the culture of bullying and harassment.

I know that other committee members who participated in this inquiry with a great deal of goodwill and consensus will want to make comments. Time does not permit me to go into great detail; however, I was very disappointed—and my children say that when I say I am disappointed it is the worst criticism—that the whole of the committee was not able to support a draft recommendation against paramedics from the Ambulance Rescue Service going across to the fire service. As chair and as an individual member of the committee I could not see any justification for that move. Another motion to be debated may enable that matter to be discussed further. There was no justification for that function being moved. There must be another agenda for the move, and I am disappointed that the Government has taken that action at this time.

Ambulance officers in New South Wales are outstanding individuals on whom we rely during times of crisis. They need all the help and support we can give them. I look forward to the Government's response to this report. I hope that it will adopt all the committee's recommendations in relation to this important inquiry. I thank all participants in this inquiry for sharing their experiences with the committee. I know that for some it was very personal and emotional, and I am sincerely grateful for their contributions. I am grateful to my fellow committee members, and particularly to the secretariat staff for their hard work during this inquiry. I recommend this report.

The Hon. CHRISTINE ROBERTSON [2.44 p.m.]: In speaking to this report I add to the statements of the Hon. Robyn Parker in relation to the value of paramedic services within New South Wales. The general public and members of this House recognise that without such a magnificent service our health services would be nowhere near as good as they are. However, I found the process of this inquiry personally distressing. I believe that upper House inquiries have an incredible ability to add value to the policy processes within the Government of New South Wales. I and other members of the committee believe that other agendas were involved in the process of this inquiry. It was most unfortunate that the inquiry was undertaken during industrial disputation. I do not believe there was a particular political agenda but there was certainly an industrial agenda, which meant that often the messages the committee was looking for, and the terms of reference, became confused.

Fortunately for the committee, at about the time the report was handed down rulings were also handed down from the industrial court on those particular issues. But in the meantime there was some frenetic gathering of evidence, not by any particular individual on the committee but certainly by some people from outside, and that meant there were very confused messages. The outcome is that the report somehow managed to ignore much of the information that the committee received about the changed management processes that had been instituted within the Ambulance Service of New South Wales during the past 10 years or so. I do not have the proper figures in my head but particularly in recent times there was questioning within the Ambulance Service. Health department policy processes in relation to specific issues brought forward in our inquiry previously had been dealt with but I do not think the committee dealt with them appropriately in this report.

I believe the report contains very healthy recommendations for the future of the Ambulance Service and paramedics. Certainly the deliberative meeting of the committee was a very long and heated affair that resulted in a consensus on some issues, despite the massive dissenting report at the end of the report. I congratulate the work of individual committee members in that regard. However, in the long run other agendas were running and the committee certainly did not reach assent on every issue in relation to the report. Unfortunately—or fortunately, whichever way it is looked at—the Ambulance Service in New South Wales is one of the most audited and reviewed government services. Whether that is good or bad is questionable but it means there is a constant culture of questioning. Another inquiry from the Premier's office was being held simultaneously and its report fed this committee's report. In 2007, following an audit in 2001, the Auditor-General said:

We commend the service for extensive changes it's made to implement the recommendations of the 2001 Audit Report for its new initiatives and for the improvements in range and accuracy of data and performance indicators.

The committee was given evidence that the work that has gone into delivering performance indicators to work with paramedics in order to ensure that they could prove the value of the individual parts of their work, and how they were operating, was very extensive and was something from which the committee gleaned a lot of information. However, a lot of that information was unable to be delivered. I found the academic evidence of an expert about harassment and bullying fascinating. The witness informed the committee that it was very difficult for people and organisations to agree on the difference between harassment and bullying. He gave us very tight definitions, which are not in my head at the moment. It was fascinating that as he described the definition of a bully, almost all in the room looked up and registered that bullying is often part of our daily experience.

It must be recognised that many workplaces have issues with harassment and bullying. Policies within the health service are fairly well defined. If the entire health service, not just the Ambulance Service, and those who operate the policies within the service read the submissions, transcripts and information received by the committee on bullying and harassment, all government departments could add value to their services. Fortunately, committee members obtained incredibly good information about defining exactly what harassment and bullying mean.

I will not address each individual item on which the committee members dissented; members can read those arguments in the report. I recognise that the Hon. Robyn Parker is distressed about a certain issue in relation to the ambulance and emergency services first-response process. I believe very strongly—and this is not part of the dissenting report—that in an emergency it is essential that paramedics be on site as soon as possible. My strong belief about this emanates from a major car accident that I experienced. I have not recorded the details of that accident, but will do so now. The Ambulance Service person was not available as fast as the State Emergency Service person. The triple-0 operator informed the State Emergency Service of the accident—I have a form of evidence from the Ambulance Service that establishes that—and the State Emergency Service personnel decided to wrench me from the car urgently, causing amazing things to happen to my legs. The Ambulance Service person was incredibly disturbed when he arrived. He was too late: I had been wrenched from the car. The State Emergency Service person said that the car was on fire. My passenger, who remained conscious, said that my car was not on fire; the other car was on fire. In that incredible situation the person who should have been responsible for the health of a human being was not on site at the time. This problem will not be fixed by having our incredibly valuable paramedics, who are trained in extra emergency services, in a special van to enable them to be first on site for an emergency rescue. That does not solve the individual problems.

In order to ensure that a paramedic is on site, that provision must be written into the emergency response procedure: an Ambulance Service person or paramedic must be available when a rescue of a human being is performed in order that medical services are applied. Paramedic services are an incredibly important component of health services. I would argue very strongly that rather than have a few specific vehicles set up for the rescue service we must ensure that the paramedics are involved in general emergency services. I stress that because recently I saw a paper that referred to certain other emergency services that were awaiting training to become first-response medical teams. That is not an appropriate reaction to the recommendations contained in the report. I encourage members to watch what is going on with that and to ensure that we have paramedics on site when rescue programs are undertaken for human beings who require a medical service.

The Hon. MARIE FICARRA [2.54 p.m.]: It was with great honour that I served as a Coalition member on the General Purpose Standing Committee No. 2 inquiry into the continuing problems within our highly valued and respected New South Wales Ambulance Service. There is no denying that the nature of ambulance officers' work has changed dramatically over the past decade, with increased expectations and correspondingly increased demand. Staffing resources have failed to match this demand. Much more needs to be done in educating the public in the most effective use of such acute care services, such as has happened in the United Kingdom.

The Ambulance Service of New South Wales has been the subject of 11 inquiries since 2001, and eight years of Auditor-General's reports, but still the chief executive officer and senior executives continue to ignore the glaring problems for which they are responsible. In doing so, they devalue the enormous goodwill, professionalism and dedication of our ambos. This inquiry was established to examine the alarming increase in reported incidents of bullying, abuse and harassment that tragically played a significant role in many cases of suicides and the taking out of apprehended violence orders by people in the service, as well as related incidents of depression, stress, self-harm, and family and relationship breakdowns. That is all indicative of an unhealthy workplace and a demoralised workforce. Clearly, this is a matter of urgency for us all.

The Ambulance Service chief executive officer and fellow executives, along with the Department of Health and successive health Ministers, have repeatedly ignored the serious problems within the service, increasing the pain and frustration of our ambulance officers. Surveys show that 75 per cent of paramedics are unhappy. Understandably, they are inquiry fatigued and inquiried out. A bleak picture was painted of low staff morale, unresolved conflict and a nepotistic old-boys club. There are too many uncaring and inept senior and middle managers with no human resource skilling, no conflict resolution training and poor people-management skills. They care more about their budget and their individual performance indicators than they do about their primary asset, their staff. A submission, representative of so many, stated:

Today's senior managers are so budget focused that they seem to have forgotten that the road staff are a group of caring human beings, working in difficult circumstances, to provide care to a growing number of sick, infirm and injured people.

Management training will now be compulsory for all current managers, with 400 operational managers to be trained by the end of 2009 and a regional expansion to follow. Significant concerns were raised regarding the Professional Standards and Conduct Unit [PSCU] as being biased, unaccountable and under-resourced. Mr Cyril Brown, a solicitor who worked within the unit, said:

I am convinced the PSCU is actually more a tool of abuse by the CEO rather than a responsible professional unit. The PSCU holds a biased attitude and arrogance that imposes mounting and prolonged pressure on investigated officers.

Another submission stated:

by the time the PSCU becomes involved, the number of parties has increased, positions have become entrenched, staff have become factionalised, memories have become eroded and the evidence is compromised.

The committee recommended an independent process be established to enable staff to appeal against decisions of the unit. Inadequate staffing often leads to related stress and fatigue, with officers attending major traumatic incidents rostered for duty before they have had time to be properly counselled or receive psychological attention. Managers are often short-staffed and may lack the empathy or skills to handle their workforce. Recently the Industrial Relations Commission handed down a decision that improved rates of pay for paramedics and front-line managers, which better regulates the length of their shifts and mandates paid rest breaks and gives great employment flexibility—all steps in the right direction, but there is still much improvement to be implemented.

The Minister for Health and his director general must now ensure that the chief executive officer, Mr Greg Rochford, and his senior executive team fulfil their duties. The public expect the inquiry recommendations to be adopted by the Government and implemented all the way down the line with the public reporting back to Parliament; that is, quarterly performance reviews of the chief executive officer along with his senior managers undergoing rigorous assessments to determine their suitability for their current positions.

New South Wales Health is to amend its grievance resolution policy to put greater emphasis on confidentiality provisions. Selection panel members will have clear guidelines based on merit selection, and breaches of conflict of interest and corrupt conduct will result in disciplinary action. Paramedic training requirements for clinical training officers will be uninterrupted and regularly scheduled. We have recommended that the Minister for Health initiate discussions with the Council of Australian Governments to achieve national registration of paramedics. Inadequate operational numbers on the Central Coast and the Hunter are to be reviewed and the results made public. All "on duty" crews in the Hunter are to be two-man crews by June 2009. Satellite navigation units and portable radios are to be supplied at the end of 2009.

New South Wales is the only State without a dedicated ambulance Act. Accordingly, we recommend that such an Act be introduced as soon as possible to enshrine the recommendations of this report, to provide more protection for ambulance officers in relation to disciplinary and professional conduct issues, and to ensure more accountability of the chief executive officer. It is to be hoped that the creation of a board of directors will provide accountability and monitoring of senior management of the service, with at least one director elected by members of the service. It is to be hoped that a healthy work environment for ambulance officers can grow from all this harrowing self-reflection. There is no place for bullying, abuse and harassment within any workplace. It must be emphasised that most paramedics we spoke to stated that they loved being a paramedic, and it is our duty to support them.

I wish to thank the chair of the committee, the Hon. Robyn Parker, and my cross-party colleagues for their support and dedication to the welfare of New South Wales ambulance officers. Importantly, I wish to thank our resourceful and professional parliamentary clerks who enabled witnesses to feel valued and comfortable with our investigative processes. Most of all I wish to congratulate and thank the many courageous New South Wales ambulance officers who provided the inquiry with a balanced and accurate assessment of their workplace. We clearly need to improve the culture, recruitment, management and working conditions within the service so that we can achieve a supportive and healthy workplace for all ambulance officers as they live up to their service motto, "Excellence in Care".

The Hon. TONY CATANZARITI [3.03 p.m.]: I appreciate the opportunity to speak to this report. I think that this inquiry is one of the sadder examples of the committee process of this Chamber in that it has not given the valuable service to the community that our committees so often provide. While there are problems within the Ambulance Service of New South Wales—and the report in places reflects this, especially when quoting evidence given by senior management of the service; and New South Wales Health confirms the existence of those problems—a great deal of the material used in the report is one-sided, untested and unsubstantiated. I acknowledge that evidence contained in the submissions and received from witnesses was disturbing. I acknowledge also that senior officers and bureaucrats supported some of this evidence. I contend, however, that the general tenor of the report paints a picture of the Ambulance Service that is not honest and is not correct, and could seriously undermine, without it being warranted, the public's confidence in the valuable work of our ambulance officers and paramedics.

I remind fellow committee members that when an inquiry of this nature occurs, in which so many of the submissions are confidential, the committee should not just simply accept such submissions prima facie; it has a responsibility to apply a greater level of scrutiny to the evidence and conduct stronger tests of its validity. The committee failed to do that in this instance. Even when the department and its senior officers were given the full details of complaints contained within the submissions the committee deliberately, in my opinion, failed to take into account the answers provided and to properly record those answers. Instead a great deal of material is simply taken untested from submissions and presented in the pages of this report as cold, hard fact.

I am saddened that the committee took that approach, and I think that had a majority of the members applied a little more rational thought and shown more interest in adopting a balanced approach, this report could have been much better. For example, I believe the committee failed to note that the level of bullying in the Ambulance Service is no higher than in any other arm of the public service. It failed to note also that evidence, in the form of claims to WorkCover, shows that the level of bullying in the service has remained stable. While we all hope to provide workplaces in which there is no bullying—and there are programs in place to achieve this—it is clear, at least in my mind, that the Ambulance Service is not suffering from problems that are dissimilar to those evident in other services.

It is clear in my mind also that the Ambulance Service is going through significant reform in this regard, and that people such as the Auditor-General have recommended reform. Such reform processes always bring stress into an organisation. Some believe that such reform goes too far, too fast, while others believe that it is neither far-reaching enough nor progressing as quickly as they would like. As we all know, change management is a difficult process that leads to conflict within and outside organisations, and parliamentarians should be careful how they react to the various interest groups within those organisations.

I am not happy with this report. However, despite its underlying intention to merely embarrass the Government, a number of its recommendations will help to improve the Ambulance Service. The work of the Ambulance Service is by its very nature stressful, and the report contains some good recommendations relating to the way in which individuals as well as systems and procedures can better manage that stress. Unfortunately, occasionally ambulance officers and paramedics are attacked and abused by members of the public. Consequently, the procedures and safeguards to deal with such issues should always be under review to improve working conditions and responses to the traumatic nature of the work they do in our community. I hope that members of the service who have problems, whether they relate to bullying, low morale or concerns with certain procedures, will find that things improve as a result of the recommendations of this report. I say this because it is important that the work done by the Ambulance Service and its staff is recognised and valued in the community.

Despite my misgivings with the politics underlying the report, I look forward to seeing the Government's response as I believe that the report and its recommendations will be seen by the Government as a further opportunity to continue improving this valuable service, not just for members of the public, who will from time to time rely on it to save their lives, but also for the important people who work in the New South Wales Ambulance Service.

The Hon. JENNIFER GARDINER [3.08 p.m.]: I commend General Purpose Standing Committee No. 2 for its report into the management and operations of the Ambulance Service of New South Wales. I will focus on some of the issues that have been raised in this inquiry, particularly from a rural point of view, but before doing so I make this introductory comment: I would love to know who wrote the Hon. Tony Catanzariti's speech! There are many parallels between the findings in the report on the culture of the New South Wales Ambulance Service and remarks made in the Garling report—which, no doubt, we will hear more about next week—on New South Wales hospitals. Mr Garling said the culture of hospitals has to change so that it is patient focused. Here we have a report that recommends that the Ambulance Service shift its focus from just budgets and performance to people, particularly to the splendid people who work in the service.

I refer to a few of the committee's recommendations. The committee acknowledges that many management issues have been raised and references have been made to previous inquiries that have made the same recommendation—that the Government seriously address the many management problems that have been left unresolved for a long time. Many ambulance officers are concerned about their workplaces and their managers. The committee noted that the chief executive team of the Ambulance Service had failed to implement much-needed reforms to solve those fundamental cultural management problems, even though it had been aware of them for nearly 10 years. According to the committee, the inaction of the senior executive team played a significant role in the current state of the affairs of the service, which generated the inquiry.

Urgent reform is necessary for the service to regain the confidence of its employees. Some initial recommendations refer to those needs, including those that will ensure that the senior executive team is held fully accountable for its performance, and that the Minister for Health and Director General of Health are kept abreast of much-needed action relating to bullying and harassment. Much of the focus of the Royal North Shore Hospital inquiry was also on bullying and harassment. It is a sad state of affairs but one that must be confronted by Government and Opposition members.

From a rural perspective, the committee recommended that the Ambulance Service of New South Wales should look at the feasibility of conducting rural recruitment drives. The committee pointed to a number of issues regarding postings, relief and on-call duties in rural areas that were raised in the inquiry. The lack of incentives to work in rural and remote areas was criticised by a number of participants who also criticised the inconsistent and unaccountable transfer system of the Ambulance Service. Paramedics told the inquiry about the limited training and clinical progression of opportunities in some rural areas, and throughout the inquiry ambulance officers raised a number of issues relating to rural postings. One of those issues related to the lack of support provided by the Ambulance Service to assist officers in relocating, including providing support for their families.

One of the submitters said, "When other officers in my class asked for assistance they were told that the Ambulance Service of New South Wales had employed them and not their family, and that they had to deal with it." That attitude should not be paramount when recruiting personnel to the health sector in some parts of this State. We have to look at members of a family as a package and make it appealing for people to work in particular locations. Inquiry participants criticised the Ambulance Service for not providing incentives for working in rural areas. Another submitter said, "Why is it that the police have incentives? Why is it that the Fire Brigade has a waiting list for its members to go to the country, yet the Ambulance Service has a big revolving door in rural and remote New South Wales?"

Several inquiry participants suggested that many of the problems relating to rural postings and transfers could be overcome if the service recruited locally. That theme is evident in many inquiries seeking to improve the critical mass of people such as doctors, nurses, paramedics and other allied health professionals. Another rural issue related to training. The committee found that the opportunity to advance to intensive care paramedics level was available only to officers who lived in metropolitan areas or in a small number of rural areas, and that caused many ambulance officers considerable consternation. The Ambulance Service acknowledged that it was slowly starting to evolve the training to be more inclusive of country officers—an amazing statement in itself—but that country officers were still disadvantaged compared with their city counterparts by virtue of the fact that it is so much harder to become qualified as a full paramedic in the country.

The committee believes that the lack of availability of intensive care paramedic training in rural areas places both rural paramedics and rural communities at a significant disadvantage. The committee noted that the training that is currently available in Dubbo and Wollongong should be extended to more rural areas. That is a very good recommendation. The committee noted that there was need for increased capital works for the upgrade and repair of ambulance services across the State. The North Coast ambulance sub-branch, which is part of the Health Services Union, noted that many stations on the North Coast alone required long-overdue maintenance.

Ambulance stations need to be repaired to address occupational health and safety hazards and aesthetic and comfort issues such as the replacement of station roofing and painting, plumbing and drainage maintenance, and some other minor but important works. For example, ambulance stations at Maclean, Bonalbo, Urbenville, Murwillumbah, Byron Bay, Evans Head, Kingscliff, Mullumbimby and Kyogle all require that sort of work—a reflection of years of a Labor Government that has failed to invest in basic infrastructure right across the board. Ambulance infrastructure is just another unfortunate example of that.

There was another interesting parallel in the findings of the Garling report into the hospital system—that is, the difficulty experienced by people who come into contact with others in the health service, such as paramedics in hospitals, to identify the personnel who are there to help them. Patients did not know what role paramedics were playing or how paramedics might be able to help them because they were unable to identify the uniform that was being worn by paramedics. Concern was expressed that the new ambulance officer uniforms bore a striking resemblance to the uniforms worn by police. It was suggested that in certain situations that could add to the confusion.

The Hon. Robyn Parker: Where are they made?

The Hon. JENNIFER GARDINER: They are not made in Cessnock. One paramedic said:

It may seem a fairly insignificant thing to some but I have noticed since we changed uniform, going from a white shirt and blue pants to a dark blue uniform, the number of people have commented in public that we look a lot like police.

Paramedics believe that in some cases that could put their lives in danger. An important recommendation of the committee was that a New South Wales board of directors should be established, as existed in past years. That lack of governance and accountability and lack of a better reporting system, which is evident right across the health and hospital system, will see the demise of this Government. The final recommendation to which I refer deals with the provision of a specific ambulance services Act to bring New South Wales more into line with other jurisdictions. I pay tribute to the committee for its important work and I place on record my great admiration for the work of Ambulance Service employees throughout New South Wales.

Reverend the Hon. Dr GORDON MOYES [3.18 p.m.]: I participate in this debate as a member of General Purpose Standing Committee No. 2, which inquired into the New South Wales Ambulance Service. The inquiry was one of the most difficult of those in which I have been involved as a member of Parliament, as a high degree of emotional commitment was required to deal with the many distressing stories that were related to us by many ambulance officers, and the members of the committee had to deal with internal conflicts that often were politically based. There is no question that citizens in our community hold the New South Wales Ambulance Service in high regard. If a poll were taken to discover who are the most trustworthy and reliable people in our community, I am sure that paramedics would be among those most favoured. Our visits to ambulance stations, the taking of evidence from individuals, and the personal inquiries that we conducted revealed an environment of tension and conflict. As was mentioned earlier by others in this debate, the New South Wales Ambulance Service has been under scrutiny for a long time. In fact, for the past 10 years or more a constant stream of inquiries has been held into the service.

It is axiomatic that the holding of a significant number of inquiries and an investigation by the Auditor-General year after year is an indication that something is inherently wrong within the service. The Auditor-General said in 2007 that despite a number of the 2001 recommendations being put in place, the fundamental culture and unhappiness of paramedics had not changed. The committee heard evidence from a large number of individuals, having received 261 submissions. As other members have mentioned, the large majority of the submissions were anonymous because people felt so emotionally tied up with the whole situation.

Committee members also conducted a number of personal interviews with ambulance officers away from the inquiry. For example, I recall an occasion when I took a relative who was suffering a heart attack to Gosford Hospital emergency ward. I remained with him all night because no beds were available at the time. Standing around with me were about 10 ambulance officers all of whom were waiting for their patients to be processed through triage and have a bed found for them. They too remained there all night. While standing with them I took the opportunity to conduct personal interviews to ascertain their feelings about the service with regards leadership, management, culture and bullying. From that random selection of approximately 10 officers I heard exactly the same stories as those given in evidence to the committee.

As a result, I encouraged some of the officers to give evidence to the inquiry, and some did. I did not realise in doing so, however, that I was exposing myself to receiving private telephone calls at my home from ambulance officers and paramedics to make reports or complaints to me rather than to the committee by way of evidence. The reason they would not give evidence was the complications inherent in whistleblowing; they felt they would be victimised in the workplace and that they could not be open and honest even to a parliamentary inquiry. The officers who contacted me, and those who gave evidence in the inquiry, painted a very clear picture of their workplace conditions. In addition to their work environment being, by its very nature, often demanding, emotional and stressful—caring for and taking people suffering strokes and heart attacks to hospital, or pulling victims from car crash wreckages and the like—they also felt that they were not being supported by their management teams.

One female paramedic related to me an occasion when, after a particularly distressing experience in her workplace, she went to her manager upon her return to her station to unload her feelings and to seek some support from him as a manager. She said that it seemed to her that the main concern of the manager was that she get back on the road and working again. Such a managerial attitude results in low staff morale and delays the successful return to work of staff, and most managers reject it as belonging to the old culture that one has to be tough to work in this particular field. Some officers picked up on the strong hints that were being made to them that to survive as a paramedic one had to belong to the old-boys club and culture. I suspect also, although the committee's report does not address this matter, that sexism is very much alive within the Ambulance Service. Female paramedics do not receive the kind of support they need, particularly in harrowing and emotional situations. The committee's report does not indicate as much, but after hearing comments of that nature time and again, I believe it to be the case.

I remember speaking to some senior ambulance officers from Penrith and some inner-city areas about the system of promotion and the way that officers manage to go through the network. To my mind the promotion system within the Ambulance Service is very unsatisfactory. Many have been promoted simply because of their length of service or because of whom they know, while others who may have superior clinical skills as paramedics do not receive the recognition, by way of promotion, that they deserve. The whole cultural issue within the Ambulance Service must be addressed.

Honourable members have referred to cases of bullying and harassment. I do not doubt that the Ambulance Service has a much higher rate of bullying and harassment than is found in other similar services. Although the committee heard evidence that the Ambulance Service is no worse than any other service in this regard, there were repeated reports to the contrary by those who gave evidence. The fact that this issue was raised repeatedly is evidence of its existence. Certainly, there was no evidence of any effective methodology to handle the bullying and harassment, or to resolve conflicts and other simmering problems. South Coast paramedics spoke about incidents of bullying and harassment under not only one manager but under numerous managers. This systemic problem within the Ambulance Service must be wiped out.

I turn now to the particular role of the chief executive. Unfortunately, given the emotional nature and pressure of the work of paramedics, the sad end to most bullying and harassment episodes is suicide. A few isolated suicides are in themselves distressing, but suicides in the numbers related to the committee in evidence is suggestive of a system lacking services or networking resources to help resolve conflicts and to provide mental, emotional and psychological support for those who feel they just cannot continue under the pressures. When staff members become extremely distraught, they need specialised attention and care. It is quite obvious that geographic pockets exist within this service in which that kind of care has not been provided by senior management.

I do not approach this issue from a political perspective, suggesting that all the bad things have occurred in the past 10 years and that, therefore, it is the fault of the Labor Government. This problem has existed for a significantly long period without any correction. For more than a decade there has been no satisfactory resolution to some of the systemic problems within the New South Wales Ambulance Service. This brings me to my final point, which is a reflection on the chief executive. I spent time alone talking with the chief executive— [Time expired.]

The Hon. ROBYN PARKER [3.28 p.m.], in reply: I thank members for their contributions to the debate. I have already thanked the committee members, but I should like to comment on some of the comments made by the Hon. Jennifer Gardiner and others about their experiences with rural care and the Ambulance Service. Ambulance officer is our most trusted profession. Indeed, the Department of Health advertises this fact on its ambulances: "Join the most trusted profession".

The New South Wales Ambulance Service has a motto of excellence and care. The quality of care offered by New South Wales ambulance officers to those of us who need their services is outstanding. But often that care is provided under circumstances of extreme emotional difficulty for the officers who provide it. Who knew? The Government knew. Lots of players have known about that for many years. As a member of the committee, I find the suggestions by the Hon. Tony Catanzariti that much of the evidence was untested quite surprising. I completely reject his comments—indeed the Hon. Tony Catanzariti seems to be operating in a parallel universe—because they do not reflect my experience.

Pursuant to standing orders debate interrupted and set down as an order of the day for a future day.