Note: Where available, the PDF/Word icon below is provided to view the complete and fully formatted document
 Download Current HansardDownload Current Hansard    View Or Save XMLView/Save XML

Previous Fragment    Next Fragment
Wednesday, 9 March 2005
Page: 17


Senator RIDGEWAY (10:43 AM) —I also rise to speak to the Medical Indemnity Legislation Amendment Bill 2005. This is one of many such bills that we have dealt with over, as I recall, the last three to four years. It essentially deals with amending several of the medical indemnity acts to ensure that the Run-off Cover Scheme operates according to the government’s original intention and it addresses concerns raised by the insurance industry and the medical profession. The changes enacted by the bill are relatively minor, technical and uncontroversial, making only small changes to the operational nature of the current medical indemnity scheme.

The legislation is the 12th in a series of bills to put in place arrangements to address the medical indemnity crisis. The Senate, I believe, has been more than accommodating, especially in recent years, to ensure that the situation is brought under control. The Australian Democrats have supported previous bills in order to ensure adequate medical indemnity cover and a capacity for medical services to be provided, especially in the public health system. These changes in themselves are not what I would regard as problems.

The Democrats support comprehensive professional indemnity insurance to ensure that consumers have access to relief in cases of malpractice. I want to, however, take the opportunity to speak about a group of people in our nation—and I have raised this on many occasions—who provide an essential function within the health system and who do not get similar urgent treatment or concern, either from the government or from the insurance industry. In this particular case, I am talking about midwives.

We are not saying that the government should not care about making sure we have a viable medical profession in this country. What we are saying is that it is beyond time for there to be direct government intervention in this sector to address the fact that midwives have been completely left out of the equation. I understand that the Minister for Health and Ageing, Mr Abbott, has given an undertaking to possibly intervene. I think there is some sort of stand-off in terms of the medical defence organisations and the insurance industry opening the door or at least coming up with the right sort of policy cover. But at the same time there is no movement from the government, either. I would encourage it to go down that path since nothing seems to have changed in recent years regarding midwives.

The background to this is that childbirth—and this is especially important following International Women’s Day—has significant social implications for individuals, families and the community. In most cases, this is a normal physiological event. Maternity care is unique within the spectrum of essential health care services provided to all Australian communities as a woman’s pregnancy, a child’s birth and the nurture of a newborn are not usually related to illness. There are only a minority of women and/or babies that require medical services

As I have said on previous occasions, according to the World Health Organisation the most appropriate primary care providers of maternity care are midwives acting on their own professional authority. This is reflected by maternity service arrangements in the United Kingdom, the Netherlands, New Zealand and Canada, for example. In Australia, public funding for basic maternity care is only provided for doctors and hospital based care. This creates an anticompetitive environment, protected by Medicare and the health funding agreements between the federal and state governments, which excludes midwives from providing their expertise to pregnant women, particularly during pregnancy.

I believe that the current monopoly enjoyed by the medical profession as the primary provider of maternity care should be dismantled in the public interest. The exclusion of midwives from primary care is not beneficial for childbearing women. The Democrats support equitable access for all women to the basic maternity care of their choice and equal pay or reimbursement for equal work for doctors and midwives when providing basic maternity care.

Midwives in Australia are educated to provide holistic care from early pregnancy to several weeks after birth for well women. They are also trained to detect abnormalities and to refer women for specialist opinion or treatment. Midwifery skills are underutilised in the current health system. Reform of maternity services to enable midwives to act in a primary care role would have a positive impact in all communities and assist in relieving pressure on medical services. Midwives are specialists in healthy pregnancy and birth, which is experienced by about 80 per cent of women. Approximately 250,000 women per year in Australia require basic maternity care. Of these, it is anticipated that about 20 per cent may require some level of medical care, while all require midwifery care.

This parliament has dealt with several bills in recent years to put in place the government’s arrangements to provide subsidies to certain sectors of the medical profession that are seeking medical indemnity cover. However, the government’s response still excludes medical professionals, especially midwives and others within the medical sector, that are not covered by medical defence organisations but which are vital to the health system.

I have been very concerned about the question of midwives needing to get some sort of cover or at least support from government so that they can practise in this country. Of the 250,000 births in this country, it ought not be lost on us that 98 per cent are attended by midwives. Rarely do you see the doctor, the obstetrician or the gynaecologist come into it unless there is a need for medical intervention. It has already been shown that midwives are often the better option for the periods before, during and after the birth of any child. Birth is much more than what happens at one single point: there is the whole process of before, during and after, and midwives are the people who can best deal with that. That is one of the benefits that a good public health system should provide. Over the last two years, though, when the issue has been raised the government has not been able to come to the party and some 12½ thousand midwives in this country, particularly those who are independent and those who work on contract, have been put out of work.

I spoke recently with the Australian College of Midwives. They have informed me that they have received advice from Treasury stating that there is no reason why midwives could not get cover from medical defence organisations. You have to ask: why doesn’t this happen? Why aren’t medical defence organisations opening up their doors and providing the right cover and adequate cover for midwives? One of the reasons is that the midwives are regarded as being a small group. They do not have the clout of an entire nation full of GPs, to whom the government listens whenever they open their mouths.

The second is that the medical defence organisations are run by doctors. This should not be lost on us: MDOs are run by doctors, so of course they are not going to agree to provide cover to their direct competitors—as they see them—if they do not have to. They are running a closed shop for obstetric care and do not want to see their monopoly affected. They do not want to accept competition from non-doctors by legitimising them through the insurance system. But the fact is that people choose midwives. That is what is happening in this country, and these midwives have to practise illegally. Thanks to the professional indemnity legislation that has been passed in most states, midwives—who are willing but unable to purchase cover—have had to conduct their businesses in contravention of these laws.

For example, my home state of New South Wales has the Health Care Liability Act, in line with the recommendation of the Ipp review that there be legislation in states to protect consumers by requiring that all professionals have indemnity insurance. That legislation was introduced in New South Wales in 2001, and since then midwives have been operating illegally. Nurses and midwives organisations have turned a blind eye so that their services can continue, but it really is an unacceptable situation that here we are, some four years down the track, and we still have not resolved this question. It seems to me that virtually all of the states, except South Australia, have introduced similar legislation. The legislation is supposed to be a consumer protection measure, but consumers of midwifery services have no protection.

There was an interesting article in the Adelaide Advertiser on Monday referring to this problem. Women in South Australia are having home births without insurance cover because independent midwives still cannot get liability insurance coverage. Justine Caines, the National President of the Maternity Coalition, is quoted as saying, ‘We think it is outrageous midwives have not been given the same professional respect’ as GPs and obstetricians. A spokeswoman for the federal government is quoted as saying that the government were ‘not aware’ that independent midwives were working without indemnity cover in South Australia. This is not the case. They have been made aware of this situation by me and others in this place on many occasions. I do not believe that the government can plead ignorance any longer. Leadership is required to resolve this issue.

It is time for the federal government to act. It is not enough for the government to say that they are not insurers. Firstly, that is plainly untrue. Under the medical indemnity schemes we have enacted, where a doctor’s gross medical indemnity costs exceed 7½ per cent of his or her gross private medical income, he or she will only be required to pay 20c in the dollar for the cost of the premium beyond the threshold limit. The government underwrite the entire medical indemnity insurance scheme. However, this is for doctors only, and not for others and certainly not for midwives. The midwives lobby has been told the federal government are not insurers, which we see is absolute rubbish when we look at how the scheme operates. They are, but only for those they choose, such as doctors. Secondly, even if that were the case, it is not relevant. Government have to recognise the vital contribution made by midwives in our health system and take direct action to ensure that they are protected.

Health minister Tony Abbott has advised midwives representatives that if they can find a policy then he would talk with them. Doctors always had insurance cover—the problem was that premiums became prohibitively costly. So the doctors got looked after and the midwives did not. The health minister seems to think that if an insurance policy for midwives does not exist then there is nothing he can do. This is rubbish. If we can convene a roundtable discussion with the insurance industry to work out the coverage crisis in the industry, why can’t we sit down and talk about fixing up some of the things that have not been resolved? It is well within the health minister’s powers to approach and use his influence within the insurance community and with medical defence organisations to effect real change in this situation.

MDOs are covering GPs for exactly the same services that are provided by midwives, especially GPs in rural areas of this country. There is no reason why MDOs could not expand their services to cover midwives. Is Minister Tony Abbott really suggesting that if an insurance policy were available on the market for midwives he would be as strong an advocate for midwives as he has been for doctors? I would like to see that, and I encourage him to go down that path. He should, because midwives provide an essential service in our community. Their expertise, qualifications and professional status should be endorsed at the federal level. It is certainly not the case that they have a poor record with negligence cases. In fact, exactly the opposite is true. Midwives have a great record, probably better than that of obstetricians. Most obstetricians in the country have a claim pending.

There is a role for federal government in this matter, despite the health minister’s attempts to avoid his responsibilities. There is a gap in the market, and the government exist to ensure that such gaps are addressed, in the interests of the entire community, not just one sector. It is time for the government to break free of the shackles of servitude, as I call it, they are kept in by the medical profession. Things do not have to be the way they are just because the doctors say so. Doctors ought to be forced, through the MDOs, to open the door.

Social commentator Anthony P Franklin once said that a measure of our society is the degree to which we fight for the freedom to choose for all our citizens. This government has always made a big deal of ‘choice’, saying that it does not want to prescribe options for people, especially in relation to which GP they choose to go to. It is time for it to put its money where its mouth is. Why should people be forced to have obstetricians attend their births, when they would prefer the assistance of a midwife? That has traditionally been the case, since before the sixties. Why shouldn’t midwives also be protected? It is time for this government to take up the fight about real choice for all citizens in our health system.

I understand that the government is planning to set up a working party to review the whole of the new medical indemnity arrangements in the middle of 2005. I can only hope that these urgent matters are considered as part of that review. But I go further: I think we need to deal with this now and not wait until the middle of the year, because there are people out there and we want to make sure that they have adequate cover. It is not just about independent and contract midwives but also about those studying midwifery at various educational institutions and making sure that they have adequate cover when it comes to clinical placement. We need to make sure that they are dealt with appropriately. To that end, on behalf of the Australian Democrats, I move:

At the end of the motion, add “but the Senate:

              (a)    notes that:

                    (i)    midwives are still the only group of professionals that are prevented from working as they were trained and registered, and

                   (ii)    the Commonwealth promoted legislation to the States that required all health professionals to hold professional indemnity insurance (as a consumer safety mechanism), while at the same time refusing to assist one group of health professionals, thereby denying safety to a group of consumers; and

              (b)    calls on the Government to:

                    (i)    recognise that midwives provide exactly the same service as general practitioners and obstetricians in normal circumstances,

                   (ii)    use their influence within the insurance industry and with medical defence organisations to ensure the development of a comprehensive professional indemnity insurance policy to cover midwives, and

                  (iii)    refer the matter of competition in obstetrical services to the Australian Competition and Consumer Commission for urgent review”.