The Hon. SUSAN CARTER (15:48): I move:

(1)That this House notes that:

(a)staff psychiatrists have been in dispute with this Government about pay and conditions for well over a year now;

(b)on 13 October 2023 the Australian Medical Association, the Royal Australian and New Zealand College of Psychiatrists and the Australian Salaried Medical Officers Federation of NSW signed a joint letter to the Minister for Mental Health seeking an urgent meeting to discuss the psychiatric workforce in New South Wales, and according to the Minister's diary this meeting took place on 9 February 2024;

(c)staff psychiatrists are so disappointed with the lack of progress in any negotiations to resolve their dispute that they began to resign in January 2025, and at budget estimates hearings in March 2025 the Minister for Mental Health agreed that it was a "fair characterisation" that at least half of the staff psychiatrists employed by NSW Health have either resigned or flagged their intention to resign;

(d)the Industrial Relations Commission [IRC] began an arbitration hearing on this dispute on 17 March 2025, with final submissions due on 4 April 2025 but delayed to 11 April 2025 to allow NSW Health time to respond to the economic modelling evidence presented by the Australian Salaried Medical Officers Federation of NSW, but NSW Health had neither prepared nor provided any economic modelling of its own at the hearing;

(e)the finalisation of this arbitration hearing has been pushed out to 19 June 2025 as the Government could not organise legal representation which was available prior to this date, despite comments from the Minister for Mental Health that this matter needs to be resolved quickly; and

(f)a number of staff specialists delayed their resignations pending the outcome of these IRC hearings, and have taken short-term visiting medical officer [VMO] contracts to continue caring for their patients, and because of the delays, a number of these VMO contracts may expire before final submissions have even been heard.

(2)That this House further notes that:

(a)while this dispute continues there are reports of a significant reduction in services to public psychiatric patients including:

(i)reduced psychiatric services available to public eating disorders patients;

(ii)reduced psychiatric services available to patients in pain management clinics;

(iii)reduced beds in specialist mother and baby units; and

(iv)closure of the Royal Prince Alfred Hospital HIV psychiatry clinic.

(b)"mutual gains" bargaining policy implemented by this Government is providing no gains at all to public psychiatric patients; and

(c)as well as costs to patients, this dispute is costly to the New South Wales taxpayer, with additional expenditure required for the employment of locums and VMOs.

(3)That this House expresses its concern that at budget estimates hearings in March 2025, the Minister for Mental Health was unable to quantify the cost to the budget of this additional payroll, the cost of the virtual psychiatry hubs, or the cost of accommodating public patients in private hospitals.

(4)That this House calls on the Minister for Mental Health to focus on resolving this dispute as a matter of urgency.

I have brought this matter to the attention of the House because I am concerned that this dispute has dropped off the radar—unless, of course, you are suffering from a mental illness and needing treatment in a public hospital and waiting in an emergency department, perhaps the one at Westmead. Internal figures disclosed by Four Corners show that in March of this year a mentally ill 19-year-old waited more than three days for treatment and that in April three men with severe mental health conditions waited between 80 and 93 hours for treatment. Perhaps you are seeking help in a community setting, waiting for yet another locum doctor and having to repeat your psychiatric history over and over again, with predictable and damaging results. Perhaps you are an intern or resident hoping to specialise in psychiatry and struggling to get the guidance and mentoring from a staff psychiatrist that specialised training should involve. Perhaps you are a young doctor facing difficult issues without a staff psychiatrist to reach out to. Those are the groups most directly affected by this ongoing dispute, as well as, of course, the vocational psychiatrists committed to public care but exhausted by the delay and the disrespect of this Government.

The dispute is almost as old as this Government. The Australian Medical Association, the Royal Australian and New Zealand College of Psychiatrists, and the Australian Salaried Medical Officers Federation urgently sought a meeting with the Minister for Mental Health in October 2023. But that request was not met with any haste. In fact, the only urgency that is obvious in this dispute is the urgency with which NSW Health appears to be trying to recruit replacement psychiatrists from overseas. Given the huge differences between salaries in Queensland and New South Wales, not to mention between Western Australian salaries and our own, one wonders whether we will be attracting the best candidates.

Let me play Nostradamus for a minute. I foresee that the Government speaker will not address the delay occasioned by the Government's inaction, not address the real impact on some of our most vulnerable, our public psychiatric patients, and blame our wages cap. That avoidance of responsibility, that blame-shifting, is getting old. The wages cap had nothing to do with the dispute being pushed to the bottom of the pile by this Government so that there was no serious engagement by the Minister and the Government until almost half the staff psychiatrists were on the point of walking away. The wages cap has nothing do with the Government's attitude to mental health, which in their workers compensation bill sees psychological damage as having to reach a much higher threshold than physical damage before ongoing support for appropriate care is warranted.

The wages cap was not a factor in staff shortages which led to wards being opened and closed and general community uncertainty, with reports of some services being closed and later found to be actually functioning. The wages cap had no bearing on the delay in the Industrial Relations Commission [IRC], including the Government's decision to use counsel who could not make themselves available before 19 June. That is three months after the arbitration hearing began, delayed once by the Government's unreadiness to discuss the psychiatrists' economic modelling and delayed again for months by the diary of the Government's counsel.

The Government needs to take responsibility for this dispute and for resolving it expeditiously, because people are hurting. The New South Wales budget is hurting, with costs that the Minister has been unable to quantify—the costs being borne, of course, by our psychiatric patients. At budget estimates hearings the Minister for Mental Health was unable to quantify the cost to the budget of the additional locum payroll to fill some staff positions. But yesterday she announced that the cost of meeting the recruitment and retention allowance sought by psychiatrists had been costed at $7 million. That is more than 23 times higher than the cost which her ministry representatives provided to the IRC. When questioned about the difference, the Minister indicated that, apparently, it is do with apples.

I would not like to be shopping at her fruit shop if she imposes a unilateral 2,020 per cent increase and either cannot or will not explain why except by some Delphic reference to fruit. If we are thinking about comparative cost, the ministry's figures of a shade over $32 million is the equivalent of New South Wales supporting six Ultimate Fighting Championship matches. I know where I would prefer my tax dollars to be spent. The people of New South Wales deserve better. Our mentally ill deserve respect. And we need this dispute resolved urgently.

The Hon. ROSE JACKSON (Minister for Water, Minister for Housing, Minister for Homelessness, Minister for Mental Health, and Minister for Youth) (15:53): It is hard to know where to start with this motion, so I will just start with some fact checking. Firstly, the claim in the motion that NSW Health had neither prepared nor provided any economic modelling of its own at the hearing is blatantly false and a lie from the member moving the motion. NSW Health did table economic evidence and had numerous expert witnesses cross‑examined as part of its economic case. NSW Health submitted expert economic evidence with evidence from the Treasury and its chief financial officer. In fact, I have been questioned in the House about some of the details of that economic evidence.

Secondly, the statement that the Government could not organise legal representation to be available prior to 19 June, which was restated by the mover of the motion in her comments, again, is completely factually inaccurate. In fact, the date was moved to 19 June not because of supposed availability challenges from the Government side but because of the refusal of the Australian Salaried Medical Officers Federation to adhere to the orders of the Industrial Relations Commission [IRC] about strike action organised for the broader staff specialists award dispute. I invite the member to read the IRC's statement about why the date was changed. Thirdly, the statement that, because of the delays, a number of visiting medical officer [VMO] contracts may expire before the final submissions have even been heard is, again, false. There does not appear to be any acceleration of resignations following the delay to the IRC hearing.

Fourthly, the statement that the Government has provided to public psychiatric patients no gains in its bargaining is, again, not true. The interests of patients have been absolutely at the heart of the offers the Government has put on the table, repeatedly, through our numerous meetings, including a single-year increase of 4.5 per cent, which is the largest the psychiatrists have received in over a decade, and a 10.5 per cent increase over three years and a 10 per cent onerous duties allowance. All of those things were specifically targeted to try to provide a framework for bargaining with the psychiatrists in the numerous meetings we have had with them.

Of course, it is not only the things that have been included that are factually inaccurate; it is also the things not included. The idea that the Opposition bears no responsibility for this dispute, when it is clear to everyone that the wage suppression of over a decade is a directly contributing factor to our being in this dispute, is an utter abdication of its role as supposedly constructive and wannabe earnest participants in this conversation. I accept responsibility for resolving this matter. I am working hard to resolve it through multiple meetings, including as recently as a fortnight ago with the psychiatrists and the Premier. There is so much more I would like to say other than that this motion is riddled with factual inaccuracies, is false and will be opposed by the Government.

Dr AMANDA COHN (15:56): The Greens will be supporting the motion. We are not only supporting the motion; we say it does not go far enough. The motion calls on the Minister for Mental Health to focus on resolving this dispute as a matter of urgency. It should really be calling on the New South Wales Government to pay all health professionals working in mental health, including psychiatrists, at least what they would earn in other States. That is what Portfolio Committee No. 2 – Health recommended in June last year after its inquiry into mental health, and that is what will actually provide people who need mental health care in this State with the care they deserve.

This dispute is not sudden. The motion refers to the letter sent in October 2023 from the Australian Medical Association, the Royal Australian and New Zealand College of Psychiatrists, and the Australian Salaried Medical Officers Federation to the Minister for Mental Health. I read part of that letter onto the record:

We are writing to request an urgent meeting with you and Department officers to discuss the perilous circumstances surrounding the psychiatry workforce in the NSW Health. This is not a term we use lightly or for undue emphasis. We have deep concerns about the scale and urgency of this issue and the very real impact on the community This occurs in the context of workforce issues across the professional groups in Mental Health and the broader Health workforce.

NSW Health Mental Health services are responsible for the provision of care to those with the most severe and disabling mental health disorders.

That letter was sent in October 2023. In June 2024 the parliamentary inquiry said that mental health services in New South Wales were reactive and crisis driven, and recommended paying health professionals at least what they would earn in other States. We have not gotten into this mess all of a sudden.

I actually agree with the Minister that the Coalition bears some responsibility for this mess, but arguing with each other over whose fault it is will not help the psychiatrists or the people they need to be caring for. The government of the day needs to actually fix this problem. It is even worse than that. The contingency measures the Government has put in place to deal with the resignation of the staff specialist psychiatrists is making things worse, not better. We have fragmentation of continuity of care for people who need it most, we have fragmentation of training for psychiatry registrars and other junior doctors, and we have an extraordinary cost of locums and visiting medical officers, and of putting public patients in private hospitals.

I also want to comment on the dispute members are having, quite spectacularly, over the figures. The Government said the pay rise would have cost $700 million. If we divide that over a four‑year budget by the 400 full-time staff specialists that there should be in New South Wales—this is very much back‑of‑the‑envelope maths; I am not our Treasury spokesperson—we end up with a pay rise of $437,000 per specialist. But no‑one was asking for anywhere near that much. The figures do not stack up. The Minister needs to be honest about how much this is all costing so we can do what is cheaper, which is to pay the psychiatrists what they are asking for so they can get back to the work of providing continuity of care for patients.

The Hon. DAMIEN TUDEHOPE (15:59): The Minister was passionate in her defence of the decision she has taken. I wish she had gone on Four Corners and taken the same passionate approach to responding to some of the allegations that were raised regarding psychiatrists, and I wish she had defended the Government's position regarding the matter. That might have been a better outcome, given the passion she has for her position. One of the objects of the Industrial Relations Act 1996 is "to encourage strategies to attract and retain skilled staff where there are skill shortages so as to ensure effective and efficient delivery services". That object is of relevance to the retention and attraction of psychiatrists in the New South Wales public health system.

The Minister for Mental Health failed to address the deepening crisis in our mental health system before it resulted in the resignation of a significant number of psychiatrists from NSW Health. That is self-evident. In January 2025 the Minister—clumsily, in my view—further exacerbated tensions with psychiatrists by falsely claiming credit for asking the Industrial Relations Commission [IRC] to bring forward urgent arbitration when, several days earlier, the commission had already begun the process of urgent arbitration based on its concern about the impact of a failure of the Government and the Australian Salaried Medical Officers Federation of NSW [ASMOF] to make any progress in negotiations on the State's mental health services.

Hearings on the proposed new Psychiatry Staff Specialists Attraction and Retention (State) Interim Award were underway before they were suspended by the IRC as a response to ASMOF's defiance of a dispute order. The hearings, which the Minister claimed to have been urgent back in January, will not conclude until 19 June 2025. That later date was determined by the scarce availability of the Labor Government's chosen legal representative—so much for urgency. From my own years in legal practice, when a court stated the available dates for a hearing and my client wanted the matter dealt with urgently, rather than hold up proceedings based on my own full dance card, I would ensure my client's representation by another lawyer with more timely availability.

On the other hand, if my client wanted the matter to be delayed, I may have insisted on representing them to assist that outcome. The Minister's claim to want an urgent resolution rings hollow five months on from when she made the claim. The Government always resorts to the wages cap as though it is the ultimate problem in every single dispute that arises. The Opposition did not face the current issue when it was in government.

The Hon. AILEEN MacDONALD (16:02): I support the Hon. Susan Carter's motion and speak with concern and frustration at the Minns Government's inaction on a crisis it helped create. Psychiatrists have been in dispute with the Government for over a year. More than half have now resigned or signalled that they will resign. Arbitration has stalled, services are collapsing, patients are suffering and still there is no resolution. Yet the Government has cut the ribbon on the $540 million Integrated Mental Health Complex Westmead, calling it state‑of‑the‑art and recovery-focused, but psychiatrists have warned it will just be another empty shell. The new beds will not be opened because there will be no-one to staff them.

At budget estimates, the Minister acknowledged the workforce crisis but had no plan to fix it. Meanwhile, psychiatry trainees have been left unsupervised, at risk of losing accreditation, and unsure if they even have a future in the profession. Dr Helen Schultz said that those young doctors have no voice, and she is right. This is not about buildings; this is about people. The Government talks about compassion but fails to act. It is more interested in headlines than solutions. We cannot build our way out of the workforce crisis. We cannot fix mental health care with bricks and mortar if there are no clinicians to care for patients.

The Premier said the Government has made psychiatrists the best offer in a decade, but their signalled exodus tells otherwise. I urge the Minister to come back to the table, listen to the profession, protect the future of our mental health system and stop failing the people she says she represents. I commend the motion.

The Hon. STEPHEN LAWRENCE (16:04): I contribute briefly to debate on the motion because the hypocrisy of the contributions from members opposite has risen to the level of offensive. It is understandable on some cynical political level that they would seek to weaponise those issues, but the motion deals with services and issues that are important to the most vulnerable, so debate should not be the subject of that kind of crass politics. I put it that highly because one needs to be aware of the history of the matter. One of the key issues is the former Government's record, which suggests Opposition members are engaging in gross hypocrisy and politicising the issues. In 2018-19 they gave psychiatrists a 2.5 per cent pay rise, in 2019-20 it was 0.3 per cent, in 2020-2021 it was 2.04 per cent and in 2021-22 it was 2.53 per cent. In March 2023 the Minns Government was elected, and in 2023-24 we provided a 4.5 per cent pay rise and then a 10.5 per cent pay rise for 2024 to 2027. It is hypocrisy from those opposite, given they created this crisis. They had 12 years in government, and they underinvested in psychiatrists. We saw on Four Corners on Monday night those disturbing revelations, which spoke to long-term systemic issues.

We cannot turn around the ship of state, in that respect, in a short period, and members opposite know that. Four Corners reported on record underinvestment in that area. It is the height of opportunism and hypocrisy for Opposition members to introduce this motion and play politics with the issue, particularly when one of the members of the Opposition sitting in the Chamber, the Hon. Damien Tudehope, was one of the key people in the former Government that orchestrated it. I add my support to the contribution of the Minister. Those matters are before the commission. It should also be noted that the matter is only before the commission because the Labor Government changed the law to allow it to go to the commission. We changed the law so that workers in New South Wales could advocate for their rights and seek to resolve their matters before an independent umpire.

Members opposite did not allow that when they were in government. They imposed a uniform cap so they could spend government money in other ways, to their political advantage. That is why they did it. All members know this forms a significant component of the budget. Opposition members imposed a cap at the risk of essential services, and they undermined the system in a fundamental way. Now they are trying to take advantage of what they did. That is a crime.

Ms ABIGAIL BOYD (16:07): As The Greens industrial relations and Treasury spokesperson, I back up everything that my excellent colleague Dr Amanda Cohn raised in her contribution. It is very frustrating, as always, to take part in these debates, having seen both the Coalition and Labor in government. It is absolutely true that the Coalition created lot of the problem that has been handed to Labor. But Labor has been in government for two years, and it knew what it was getting into. It is true that psychiatrists were not resigning under the former Government, and I think that was because they had hope. We all had hope that when Labor came to government and took away the wages cap, everyone would have a fair wage. I think we all felt that. We all felt that there was hope, and I think that sustained people under the Coalition Government's brutal but—let us face it—honest wages cap.

We now have the idea of mutual gains bargaining, which sounds nice until we dig into it. It relies on the workers, who have been underpaid and under-resourced, to try to find something when they have nothing left to give and offer it up to the Government in return for a fair wage. In a lot of ways it is crueller and worse to make workers have to do that. We have made it incredibly complicated, when it does not need to be. Psychiatrists are getting paid significantly less than what they can get paid in other States and Territories. Even for the most market economist or capitalist person in the room, it is not difficult to understand why people might flee this system and go somewhere else.

I call on Labor to look at the reality, which is that the Government has underpaid workers, who have lost hope and are leaving in their droves. They are just asking for fair wages and conditions. This Government needs to take a step back and realise that everything it has been doing in this regard has just been wrong. It needs to have a different approach that starts from the fundamental premise of giving those people a wage that will allow us to retain them in the system and attract more people to the system. That will allow conditions to be raised and the sector to not be so under‑resourced.

The Hon. SUSAN CARTER (16:11): In reply: I thank all members who contributed to this debate: Minister Jackson, Dr Amanda Cohn, the Hon. Damien Tudehope, the Hon. Aileen MacDonald, the Hon. Stephen Lawrence and Ms Abigail Boyd. It is often said that all politics is personal. To the extent that there has been crass politics in this debate, it is because this issue is deeply personal. People need mental health treatment today and are unable to access it. People are waiting too long for mental health treatment today and are unable to access it. Would-be psychiatrists are having their training compromised. They need a voice, and our job in this place is to be a voice for those people. That is exactly what this motion is about.

The Minister may quibble with the detail in the motion. I would have been open to a discussion about refining it. I am delighted to know that there has not been an increase in the rate of staff psychiatrists resigning because of the protracted nature of the Industrial Relations Commission [IRC] dispute. However, that is to do more with the goodwill of the psychiatrists than with any positive actions taken by this Government. Absolutely, there are complex factors in the IRC. But I have been informed by psychiatrists that when they turned up with economic modelling, the Government was not ready with its own.

Ms Abigail Boyd pointed out one of the frustrating things about this debate, which is the difficulty of getting accurate data or figures. The unicorn $700 million that arose yesterday—where did that come from? The evidence at the IRC was that the wages request, including the retention and recruitment allowances, is in the order of $32 million. Are we suddenly now having forward projections of 23 years? That is new budgeting practice if so. That fanciful figure has still not been explained. The dispute needs to be taken seriously. It has gone on and on because, unfortunately, we do not see the people who are suffering and who most need to be seen. They will be seen in this House; they will be heard in this debate. Their needs will be addressed because we are here to represent them. I commend the motion to the House.

The DEPUTY PRESIDENT (The Hon. Rod Roberts): The question is that the motion be agreed to.

Motion agreed to.