Dr AMANDA COHN (21:36): I move:

(1)That this House notes that:

(a)supply shortages and discontinuations have impacted the availability of over 400 medicines in Australia, including dozens listed as in critical shortage by the Therapeutic Goods Administration; and

(b)medicines and medical products impacted include antibiotics used for common infections, pain relief used in palliative care and for cancer pain, diabetic medications that can prevent severe complications, psychiatric medications, hormone treatments used commonly for severe symptoms of menopause, vaccines to prevent shingles, multiple frequently used and critical intravenous fluid products, and many more.

(2)That this House recognises that widespread medicine shortages, interrupted supply, the use of special access schemes, and the use of alternative unapproved products, along with the ongoing IV fluid shortage, impact:

(a)patient quality of life;

(b)hospital and health service operation, including safety and quality of care;

(c)disproportionately on patients in rural and regional areas;

(d)confidence in and relationships with health professionals; and

(e)time pressures for health professionals.

(3)That this House calls on the Government to urgently explore options to:

(a)stabilise supply of essential medicines, including but not limited to domestic manufacturing; and

(b)ensure equitable availability of medications impacted by supply shortages, including to rural and regional areas.

Supply shortages and discontinuations have compromised the availability of hundreds of critical medicines in Australia, and dozens have been classified as being in critical shortage by the Therapeutic Goods Administration. Medicines affected include antibiotics for common infections; pain relief for palliative care and cancer; diabetic medications that are crucial for preventing severe complications; psychiatric medications; hormone treatments; adrenaline for emergency treatment of severe allergic reactions, cardiac arrest and asthma attacks; vaccines to prevent shingles; critical intravenous fluid products; and many more essential medicines and medical products.

Some of these medicines are facing temporary supply chain issues but, even worse, some medications, like Ordine, have been discontinued by their manufacturers because, despite their incredible benefit to those that need them, they are not profitable. Ordine is used to manage severe pain and difficult or laboured breathing in many care settings, including cancer treatment and end‑of‑life care. Medicine shortages have been more severe and increasingly tangible in Australia since the pandemic, but health and medical experts are warning us that this problem is only getting worse and that warning signs had been clear for more than a decade. The fundamental problem is that we are entirely reliant on overseas supply chains and private manufacturers for essential medicines. There is no number of special access schemes or alternative unapproved products, or other temporary bandaids, that will address this problem.

The Government must be willing to drive domestic or even public manufacturing. There are presently 394 medicines in shortage with a further 82 anticipated. In May, when 423 medicines were in shortage in Australia, those included treatments used to manage menopause symptoms, such as hot flushes and night sweats. Of the nine brands of hormone therapy patches available, eight were in short supply and the only other one was not available on the Pharmaceutical Benefits Scheme. For patients, this represents additional time, money and effort spent visiting multiple pharmacies, or making return visits to secure critical medicines, or just giving up and not taking prescribed medicine. Doctors and patients have to spend precious time and resources devising workarounds and altered management strategies.

For years the Australian Medical Association [AMA] has been calling for a comprehensive strategy for the supply of medicines—one that puts domestic manufacturing at its centre. This call was repeated in August amid the nationwide shortage of intravenous [IV] fluid. While fundamental to surgery and critical health care, the reliable supply of IV fluid is also critical to the functioning of all hospitals, outer city health services and general practices. The Federal health department has said that while a more resilient medicine supply chain was a government priority, locally manufacturing all the medicines approved for use in Australia was not practical or economic. The AMA has rightly said that we must work to prevent shortages rather than constantly responding to them. People's lives actually depend on this.

At a recent budget estimates hearing NSW Health confirmed a long list of shortages it was currently monitoring and mitigating to ensure equitable access across the State. I am grateful to Dr Kerry Chant and her team for that work, as well as for her comprehensive answers to my questions on notice and supplementary questions. But the approach of monitoring the shortages and equitably distributing dwindling supplies of essential medicines is not a long-term solution to what is a systemic and worsening problem. I commend the motion to the House.

The Hon. AILEEN MacDONALD (21:39): The Opposition supports the motion moved by Dr Amanda Cohn that calls on the Government to act to address a critical shortage of medical supplies. The motion quite rightly calls on the Government to urgently explore options for the stabilising of supply of essential medicines, and to ensure equitable availability of medicine in short supply, including in regional areas. How can it be that hundreds of medications, including dozens listed as "critical" by the Therapeutic Goods Administration, have been hit by supply shortages and discontinuations? Australia is not a Third World country. This is a parlous situation, which the Government was warned about more than a year ago but chose to ignore. The Government needs to answer the question as to why we rely on international supplies when we could and should be developing local medicine manufacturing.

Some of the drugs in scarcity are critical for life‑threatening conditions, such as antibiotics for common infections, pain relief used in palliative care and for cancer pain, diabetic medications to prevent complications from diabetes, psychiatric medications, hormone treatments for severe symptoms of menopause, and vaccines to prevent shingles. It should not be that health professionals are being forced to prescribe different brands or products that contain the same active ingredient but may not be the same dose or strength. It should not be that doctors are having to prescribe similar medicines instead of particular medicines for specific conditions. It should not be that doctors are recommending alternative treatment options. Surely the ramifications have an impact on the quality of a patient's life. The scarcity also impacts the safety and quality of care in hospitals and health service operations. It is an escalating problem that is putting patients at risk and GPs on edge.

I understand that there are many national and international causes that impact the local supply of medicines, but we are far too vulnerable to external factors. Australia imports 90 per cent of its medicines from overseas. That puts us at the bottom of the food chain when it comes to supply, because we consume only 2 per cent of the global medicines market. I support the motion because we need to address drug shortages in the short term and in the long term. We need investment in local manufacturing to help protect ourselves from those shortages. We need the New South Wales Government to stand up to the Federal Government and insist on improving the pathways for the supply of critical medications.

The Hon. EMILY SUVAAL (21:42): I thank Dr Amanda Cohn for moving the motion. The Government supports the motion. The issue of medication shortages is a global one. New South Wales has taken proactive steps to mitigate the impact of drug shortages, particularly within our public hospital system. The Australian Government also plays a pivotal role, as it has responsibility for managing current and anticipated medication shortages through the Therapeutic Goods Administration [TGA]. Medication shortages stem from a myriad of factors, including manufacturing issues, demand surpassing supply, unexpected spikes in demand and market failures. We have seen that most recently with pre-exposure prophylaxis [PrEP] and intravenous fluids.

What the Federal Government is doing in this space is amending the Therapeutic Goods Act 1989 to empower the TGA to collect data on shortages and take proactive measures to mitigate the impacts. A system of mandatory notifications to the TGA ensures timely awareness of potential shortages, enabling swift action to secure alternative supplies and minimise disruptions to patient care. In New South Wales, NSW Health is actively working to minimise the impacts of medicine shortages and discontinuations, particularly to public hospitals. That includes monitoring of medication shortage notifications and discontinuations to assess the impacts on patient safety.

Where a medication shortage has been identified, a systematic approach is taken, which includes an urgent system‑level coordination if there is a high or extreme risk to patient safety. Further, the Clinical Excellence Commission will convene the inter-agency medicine shortage assessment management team, consisting of representatives across NSW Health, to review and conduct risk assessments and determine the appropriate risk mitigation actions. Our contracts with pharmaceutical companies stipulate obligations on suppliers to report shortages promptly. NSW Health ensures that frontline clinicians are kept informed of shortages and available alternatives through regular communication channels, including dedicated webpages and the Safety Alert Broadcast System.

PrEP supply issues are expected to resolve in late October or early November 2024. NSW Health has secured a one-month supply, which will be available at NSW Health sexual health clinics and hospital pharmacies. I am pleased to update the House that intravenous fluid supply concerns are easing after a number of actions taken by the Government to support the management of that issue in its facilities. The Government has worked closely with local and international suppliers to secure supply based on ongoing requirements. I can assure the House that every public hospital has access to the intravenous fluids they require to ensure safe patient care, with clear escalation pathways in place at all NSW Health facilities should any concerns arise.

Dr AMANDA COHN (21:45): In reply: I will be brief, given the hour. I thank both the Government and the Opposition for their support of this motion. I also reiterate my thanks to Dr Kerry Chant and her team, who are doing an excellent job under a difficult set of circumstances, responding to and reacting to medication supply shortages. Giving the tripartisan support for further action, I look forward to seeing the action that the Government will take to address supply issues in the future.

The ASSISTANT PRESIDENT (The Hon. Peter Primrose): The question is that the motion be agreed to.

Motion agreed to.