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Thursday, 20 August 2009
Page: 8507


Mr DUTTON (11:51 AM) —I rise today to speak on the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009, the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009. This is significant legislation and has generated a strong and emotive response. I wish to start with what I consider the most pertinent issue that has resulted from the minister’s bungled handling of these bills.

The bills extend Commonwealth subsidised indemnity insurance to ‘eligible midwives’. A lot of the detail giving force to these bills will follow by way of regulation. To date, we and the public have been given scant detail by the government on this critical future regulation. The government has yet to provide the actuarial modelling for the indemnity insurance scheme, other than a very simplified explanation provided to the Senate Community Affairs Legislation Committee inquiry by departmental officials. It causes concern that once again this minister has rushed headlong into legislation with the attitude, ‘We’ll work out the detail later.’ It is clearly not the responsible way to legislate and, as we have seen time and time again from this government, it leads to mistakes, oversights and bungling. The parliament and the public are entitled to the detail of the policy and legislation that is to be voted on.

According to the bills, an eligible midwife is a person who:

(a) is licensed, registered or authorised to practice midwifery by … the Commonwealth, a State or a Territory;

(b) meets such other requirements … as are specified in the Rules …; and

(c) is not included in a class of persons specified in the Rules for the purposes of this paragraph.

We learn of possible excluded classes of midwives from the minister’s second reading speech. The minister stated:

… the Commonwealth supported professional indemnity cover will not respond to claims relating to homebirths.

It is the intersection of these bills with the National Registration and Accreditation Scheme where serious and genuine concern has arisen. The exposure draft of the Health Practitioner Regulation National Law 2009, bill B, under ‘Eligibility for general registration’, states:

(d) there is, or will be, in force in relation to the individual appropriate professional indemnity insurance arrangements, including a policy held, or arrangements made, by the individual’s employer that will cover the individual,

Under this exposure draft, in accordance with clauses 128 and 129, an individual who practises as a midwife without indemnity insurance and is therefore unregistered may be subject to a maximum penalty of $30,000. Come 1 July 2010, given the minister’s current position, midwives will effectively be prohibited from providing birthing services outside of a clinical setting.

This is an issue that is fundamentally about choice. It is extraordinary for a health minister to effectively prohibit mothers and parents around the country from having an appropriately qualified health professional in attendance at childbirth. I acknowledge that there is a great diversity of opinion on homebirthing, both within the medical and health fraternity and in the wider community. At every stage, though, all reasonable parties to such debate would rightly acknowledge that homebirthing is not an appropriate option for all women, and I would certainly strongly recommend that any patient, in particular expectant mothers, be properly informed and that they consult relevant health professionals. However, I am not here today to debate the merits or otherwise of homebirthing; that is for others. I am here to defend the right of intelligent, informed Australian adults to have a choice—to be entitled to decide for themselves.

To date, homebirthing is the choice of only a small proportion of women—in 2006 it made up 0.26 per cent of all births. However, it is naive to suggest that all women will simply surrender this option. The Minister for Health and Ageing knows that there are a small proportion of mothers and parents who will continue to choose not to enter the hospital system for a childbirth. That is their choice. This measure will just drive homebirthing underground, with parents unable to access appropriate care, jeopardising the lives of not just the unborn babies but also the mothers themselves. Childbirth is an intimate and personal decision for families in consultation with health and medical professionals. It is not appropriate for the Rudd government or Minister Roxon to mandate the conditions of childbirth for all women across the country. This is a nanny-state Labor government treating with contempt the rights of mature adults to make informed decisions.

Families currently privately contract with registered midwives for services outside of a clinical setting. They should be entitled to continue to do so in accordance with appropriate medical guidelines and on the advice of health and medical practitioners. I have received many compelling and reasoned pleas from parents across the country on this issue, as have many members on both sides of this House. I have met with a number of parents and their children in my electorate and in other parts of the country. Today I would like to read to the House, and specifically to bring to the attention of the minister, the concerns of Rebecca and Darryl Jenkinson, who reside in my electorate. I had the pleasure of meeting with Rebecca and her two young children in my electorate office. Rebecca provided an insightful and personal perspective on the ill-considered effects of the government’s changes. Rebecca and Darryl articulate the reasonable concerns that are so evident in this debate, and I quote in part what they wrote:

We chose homebirth with a private midwife for the arrival of our two daughters, Indiana in 2007 and Saffron in 2009. It was an informed choice, made at the culmination of much research into our birthing options. While it is ‘the road less travelled’ in Australia, homebirth is the right choice for our family and we feel betrayed by the proposed legislation.

To care for us throughout our pregnancy and birth journey, we chose a healthcare professional whose expertise is normal pregnancy and birth; we chose a midwife. Prenatal visits were as much about preparation for parenting as they were about the clinical progress of the pregnancy. We discussed the various unexpected outcomes that could arise and how we would respond to those and, when necessary, our midwife referred us to a doctor for further advice. After those consultations we always returned to our midwife’s support for our ongoing care and it was that continuity which protected our safety. By the time ‘birthday’ actually arrived, we could simply patiently allow our baby’s birth to unfold and enjoy the experience. All the while, our midwife was the guardian of our safety and would alert us if we needed to activate any of our contingency plans.

Every family is different. Every family makes different choices and those choices must be respected and treated equally by our government. Making continuous care from a known midwife more available to women is fantastic. But where we choose to give birth should not affect our ability to access that care. Our choice, homebirth with a private midwife, is valid. As our elected government we ask you, simply, to sort this out and protect our right to birth where, how and with whom we choose.

Rebecca and Darryl’s experience highlights that through consultation and genuine collaboration between parents, midwives and doctors, decisions can be made that deliver good outcomes. It might be difficult for this government to accept, but the Prime Minister and the Minister Health and Ageing do not always know best—Australians are able to make informed, educated decisions that deliver good outcomes for themselves and their families. If the minister is unable to satisfactorily resolve the issue of indemnity insurance for midwives then at least the proposed registration requirements should be amended to allow existing services to continue—the so-called status quo option. In order to have an informed debate on the provision of indemnity insurance to cover affected midwives, the government needs to release the detailed actuarial modelling that it used for its proposal.

I now turn to the PBS and MBS access for midwives and nurse practitioners. There needs to be a more holistic approach to health care in Australia, especially in the areas of preventive health and chronic illness. The skills of all health and medical professionals should be utilised to their full potential in accordance with appropriate scope of practice. Practice nurses, for some time, have been an invaluable and integral part of primary health care in Australia, and their role, skills and professional development will be central as we go forward.

However, extending access to the PBS and MBS has significant ramifications in terms of scope of practice, patient safety and the economic viability of the health budget. The interest bill alone on the Rudd government’s huge debt will make it hard in future years to meet extra expenditure on these schedules and other expenditure across the health system. It is important that PBS and MBS access for all professions is carefully considered and monitored in accordance with professional qualifications and experience.

The coalition firmly believe that GPs are the cornerstone of primary health care in Australia and it is important that there is genuine collaboration between the other health professions and GPs in managing patient health care. We have not received any clear detail on the so-called collaborative model which is central to these bills. What we do not want to see is a two-tiered system in Australia. Anyone who wishes to see a doctor for their healthcare needs should be entitled to do so. We do not want to see a situation where Australians have to see a nurse not because they want to or because it is convenient but because it is an easier solution for this government.

We need to see a genuine model of collaboration, with GPs working with other health professionals and specialist practitioners in managing patient care. It is important that there are appropriate guidelines for scope of practice, ensuring patient safety and the economic viability of the PBS and MBS. The government’s current investment in the PBS and MBS is significant. As at 30 June 2007, the coalition government spent $6.4 billion per annum on pharmaceutical benefits. Coalition government expenditure on the MBS was some $11.7 billion as at 30 June 2007. This is a significant increase from 1995-96 amounts, under the last Labor administration, of $2.2 billion and $6 billion respectively.

It is important that these programs are utilised as efficiently as possible and that they remain viable into the future. However, in order to consider that issue, the government needs to release the detail under which this legislation will operate. There is a conspicuous and concerning lack of detail behind these bills. The creation of referral rights for nurse practitioners to specialists is another significant component of this legislation. However, once again, we need to be assured of the efficiency of such a model. Currently, GPs refer a only very small proportion of patients to specialists. We ask the government to release the modelling, or at least some sensible detail as to how this measure may affect the quantity of referrals, waiting times for specialists and the MBS.

Whilst there is a logical argument for nurse practitioners and midwives to have some capacity to order pathology and diagnostic services attracting a Medicare rebate, the workability and efficiency of this proposal will entirely depend on the collaborative model, which we understand the government has not yet devised. Without a national e-health record, and without knowing how the government’s planned collaborative model will work, there is significant risk of duplication and overservicing in this area.

The health budget, provided by the taxpayers of Australia, is certainly not infinite and needs to be managed carefully to meet the worthy but almost endless demands placed on it. It is certainly one of the most difficult aspects of the health portfolio. There are many worthy causes that would benefit from funding in the health portfolio. However, the reality of the situation, and something which we all need to remind ourselves of, is that funding is provided by the hardworking taxpayers of this country and the pie is only so big. There is a duty, an obligation in fact, on government to ensure that taxpayers’ money is always used efficiently. Unfortunately this is clearly not something the Rudd government understands. We have seen billions of dollars of taxpayers’ money squandered on populist cash handouts—racking up over $300 billion in debt for the youth of this country to pay off.

As I say, the debt servicing requirements caused by the Rudd government’s reckless spending will cut deeply into key budget areas such as health in future years; and there are few portfolios where this obligation to ensure the best use of funds is more important than health. There is an opportunity cost to all initiatives. The stark reality of the situation is that taxpayers cannot fund everything. Policy needs to be considered and refined and there needs to be more consultation than what this government has committed itself to in the past. Taxpayers deserve, and the government is obliged to provide, the ‘best bang for the buck’.

The Senate Standing Committee on Community Affairs inquiry examining this legislation has received over 1,800 submissions and was due to report on 7 August 2009. The reporting date was moved to 17 August due to the overwhelming public reaction. Whilst we do not oppose the passage of this bill today on the basis of the homebirth outcome, we do reserve the right to move amendments in consideration of the recommendations of the Senate committee’s report. We are opposed to making homebirth illegal and we will fight for choice. I put the government on notice that we are carefully considering the committee’s recommendations that were released in this regard.

The minister’s bungled handling of this critical legislation follows this government’s complete mismanagement of the health portfolio. Mr Rudd and Minister Roxon made numerous explicit and unambiguous promises that a decision to hold a referendum to take financial control of public hospitals would be made by mid-2009. For example, a media release by Nicola Roxon and Kevin Rudd on 23 August 2007 stated:

If by mid-2009 the Commonwealth and the States and Territories have not begun implementing the National Health Reform Plan, a proposition for the Commonwealth to assume full funding responsibility will be developed and put to the Australian people.

As of 30 June 2009, Mr Rudd failed to state whether he would honour this promise. However, some confusion is understandable in relation to this promise, as Mr Rudd has gone to great lengths to retract it. In fact, a paragraph referring to the referendum was removed from the Prime Minister’s website between October 2008 and November 2008. Under questioning in this very parliament, the Prime Minister failed to respond as to why this had occurred. In addition, a heading ‘Fixing our hospitals’ on the Prime Minister’s website was replaced with ‘Improving our hospitals’ during the same period.

Despite Mr Rudd’s promise to fix the health system, I am inundated daily with complaints about the Rudd government’s ill-considered policy decisions and savage cuts to successful health programs. Since coming to office, the Rudd government has introduced measures to halve the Medicare rebate for patients undergoing cataract surgery, capped the Medicare safety net for a range of procedures, cut funding for chemotherapy drugs and slashed the private health insurance rebate. These measures will increase the cost of health care for many Australians and put more pressure on Australia’s already overstretched public hospitals.

We have seen as recently as this week, in question time, the minister’s inability to guarantee her own comments that IVF patients who are charged $6,000 or less per cycle will not be worse off because of the government’s cuts to the Medicare safety net. I issue the challenge to the minister, who is here in the chamber today, to live up to that guarantee, to repeat those words in this parliament. Minister, if you used those words in your second reading speech and you walked away from them during question time, why not come back and provide a guarantee to those thousands of parents right around the country—


Ms Roxon interjecting


Mr DUTTON —Mr Deputy Speaker, I would ask that the minister withdraw those comments, which I find highly offensive.


The DEPUTY SPEAKER (Hon. KJ Andrews)—If the member finds them offensive, I ask the minister to withdraw.


Ms Roxon —If he is such a delicate petal, I will.


The DEPUTY SPEAKER —I think the minister should do without the preamble. It would assist the House.


Ms Roxon —If it assists the House, I withdraw.


Mr DUTTON —The IVF parents around the country are delicate about this issue, because for them this is the difference between being able to start a family and not. This government has, unbelievably, cut the support to IVF parents around the country. Many people will not have the capacity to make a decision to have an IVF cycle. In many cases, people have to have several cycles. I have spoken in the House before about such instances where families have had to endure over a dozen cycles to make sure that they have every chance of bringing a child into this world.


Ms Roxon —Mr Deputy Speaker, I rise on a point of order. We are 20 minutes into the member’s speech. This is a bill about extending MBS and PBS to midwives and nurses. He has not yet brought himself to say anything positive about nurses. He is not being relevant to the bill and I would like to bring him back to the debate. If he has nothing good to say about nurses, he should sit down.


The DEPUTY SPEAKER —Order! The honourable member for Dickson will relate his remarks to the bill.


Mr DUTTON —The characterisation by the minister, just for the sake of Hansard, is a complete misrepresentation. This is a minister who has championed the cause of women around the country—and, in particular, the rights of nurses—and yet in this very bill this minister is saying to nurses and to parents around the country who are making decisions about how they will birth their children, ‘You cannot have a midwife, because we are making the practice illegal and we are exposing people to a $30,000 fine.’ This is a minister who would slap nurses in the face in this bill.


Ms Roxon —Mr Deputy Speaker, on a point of order on relevance again. As the shadow minister already indicated in his earlier comments, the bill that deals with ‘unlawfulness’, as the member puts it, is not currently before the House. That is the registration and accreditation bill. If the member for Dickson has nothing more to say on what are momentous changes for nurses and midwives across the country then he should sit down. He is required to be relevant to the bill.


The DEPUTY SPEAKER —I understand the point of order. The minister will resume her seat. I asked the member to direct his comments to the bill, which he did.


Mr DUTTON —Absolutely, Mr Deputy Speaker. The interjections by this minister are designed only to try and run the clock down. People should understand the strategy of the minister.


The DEPUTY SPEAKER —Order! The member will resume his seat. The minister, on a further point of order?


Ms Roxon —Yes, it is, and I know that it is difficult as the chair in this situation to be across all of the detail of the bill. This bill does not have a $30,000 fine in it. He is speaking about an entirely different bill, which is not before the House. It just shows the shadow minister’s incompetence.


Mr Randall —On the point of order, Mr Deputy Speaker: the fact is that the member is very relevant, in that IVF cycles have a fair bit to do with midwifery, I would have thought.


The DEPUTY SPEAKER —I have heard the arguments. I will continue to listen carefully to what the member for Dickson says. I repeat what I said before, and that is that his remarks should be related to the bills.


Mr DUTTON —Thank you very much, Mr Deputy Speaker. I am not getting into some petty tit-for-tat with the minister, who obviously wants to distract from the message. This is a slap in the face for those 1,800 people who made submissions to the Senate inquiry on this very bill. These people were concerned about the fact that this government is going to, by way of this legislation before the House and the national registration and accreditation process, make it illegal for parents to have a homebirth with a midwife in attendance in this country. That is unacceptable from a government and from a minister, and it is no wonder that the backlash from the backbench and from her party has been quite outstanding.


Ms Roxon —Mr Deputy Speaker, on a point of order. I am quite happy for the member to use other forms of the House to debate what is an important issue, but it is not part of any of the three bills that we are currently debating. The shadow minister, as a previous minister, knows that he should make his comments relevant.


The DEPUTY SPEAKER —It is my ruling that the member for Dickson’s remarks are relevant to the long title of the bills.


Mr DUTTON —Thank you very much, Mr Deputy Speaker. It is no wonder that these patients, these expectant mothers, these mothers who have been through the process of homebirthing and who have experienced the benefit of having a trained midwife in attendance, are so frustrated at the approach of this government, when you see the minister’s petty interjections in relation to this speech. I cannot believe that a Labor government with the people who sit opposite, who champion the cause of choice, of the rights of women, are effectively taking away the choice of those women around the country. It is no wonder that there has been revolt in the Labor Party caucus against the minister’s decision.

This is a bad outcome for those women who have a choice. Some people agree with homebirthing; others do not. But the reality is: they have a choice to make, and the fact that this government has taken that choice away is a very sad indictment of many people within the Labor Party—not just in this place but in the other place as well. I do not care what people in the Labor Party are saying in private to homebirth mothers; they are saying absolutely nothing in public. It is worthless for them to continue to show sympathy and to say that they are going to advocate behind the scenes on behalf of homebirth mothers when not one Labor female or male MP in this place, or Senator in the other place, has spoken out publicly against this minister’s stance. I know that there are dozens of people within the Labor Party who are talking to homebirth mothers in their electorates, in Canberra and in other parts of the country, and they are saying to people in those conversations that they do not agree with what this minister is doing. She does not have the support of the caucus and yet somehow this has been rammed through on them. It is a pathetic example of representational politics by the Labor Party in this country that many of those women are not speaking up.

Whether the Prime Minister has gagged them or whether the health minister has gagged them, if these people are going to stay true to the convictions that they commit to in private then they should be coming out to provide public support to their statements and they should be talking against this particular provision by Nicola Roxon. That is the important part: this provision is by Nicola Roxon, who has championed herself as some sort of advocate of nurses yet she is saying to midwives who want to continue in the practice of homebirth that effectively they are going to be fined $30,000. That is completely outrageous.

In looking at the outcomes in this bill, I have spoken to the positive outcomes and I have addressed the issues which I think need to be addressed. We now have the benefit of the Senate inquiry report, and we will certainly be looking at the option of moving amendments until this government gets it right. Until this government gets it right, we will continue to advocate on behalf of those thousands of mothers around the country who are currently being ignored by Labor members across the country. We will listen and stand up for their rights. We will stand up for choice. We will listen to their concerns because those concerns are not limited to a handful of people. Even people who do not agree with homebirthing say that those who choose to take up such an option should have that right into the future. That this health minister would take that away certainly underscores some of the difficulties not just around this policy and around the bill that is before the House but around the general approach to the issue of health in this country.

This is a government that say one thing one day and do something completely different the next day. They have not altered outcomes for the better in health over the course of the last 18 months. All Australians know, particularly in relation to public hospitals, that the situation has got worse over the last 18 months. The situation has got worse for our good, hardworking doctors and nurses around the country. They are working in conditions in hospitals—


Ms Roxon interjecting


Mr DUTTON —This is a bill which relates to midwives and to nurse practitioners; these people are working in hospitals—


Ms Roxon interjecting


Mr DUTTON —Nurses work in hospitals, Minister. I did not think she was that far out of touch, but nurses work in hospitals.


Ms Roxon —Mr Deputy Speaker, I rise on a point of order. The shadow minister is straying far and wide, but MBS and PBS items are not available to staff that work in hospitals because they are state employees and, again, he is being irrelevant.


The DEPUTY SPEAKER —Order! There is no point of order.


Mr DUTTON —The point out of all of this is that despite all the promises, all the rhetoric and all the spin lines—the way in which it was rehearsed and put at the last election that Labor had a plan to fix hospitals—I would ask people all around the country, and those nurses and doctors and other allied health professionals who are working in terrible conditions: has anything improved in your hospital over the last 18 months? Of course it has not. This is a government that have now walked away from their commitment to fix public hospitals and to make the situation better for nurses and doctors around the country. They are saying, ‘We cannot give you a guarantee—after 16 months of consultation with 10 of the country’s best health experts and despite coming up with 123 recommendations—that we will introduce any reform in health today, tomorrow, next month or indeed for the next six months.’ This is a prime minister who has now decided to go on a tour around the country for six months, visiting hospitals—


The DEPUTY SPEAKER —Order! The member for Dickson is now straying from the issue before the chair.


Mr DUTTON —He is visiting hospitals where the hardworking nurses that we are talking about in these bills are working. These are people that deserve better working conditions and yet they have been condemned by this government to the same practices that have delivered bad health outcomes by Labor governments over the last 10 years. The pouring of more money into problems, which is always Labor’s solution, is not the solution in health—without the reform of the system. We need structural reform. We do not need good money being poured after bad. Reforms need to be made to get better health and patient outcomes. This is a government which has to start thinking about the patients. We cannot continue in this country in the 21st century to have people dying on waiting lists and to have parents waiting a dozen hours overnight in emergency departments. This is a government which still condones waiting lists that are being doctored—that are publicly acknowledged as being doctored—and fraudulently put to the Commonwealth to extort funds from the Commonwealth to fund them. And the waiting lists grow longer and longer. No wonder nurses around the country—


The DEPUTY SPEAKER —Order! The member for Dickson has now strayed beyond some reasonable bounds. I ask him to come back to the issue before the House.


Mr DUTTON —No wonder they are expressing frustration. We need to continue to take the fight up in relation to this bill before the House. We will do that. We will hold this government to account because the Australian public knows that on health Kevin Rudd has only made the situation worse.


The DEPUTY SPEAKER —Before calling the next speaker, can I remind the member for Dickson that in future he should refer to members by their title or their office.