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Thursday, 20 August 2009
Page: 8524


Ms KING (1:00 PM) —I rise in support of the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and associated bills. These bills facilitate the inclusion of nurse practitioners and midwives under the Medicare Benefits Scheme and the Pharmaceutical Benefits Scheme. The bills also enable the establishment of a professional indemnity scheme for eligible midwives, which is critical to support the new MBS and PBS arrangements.

The purpose of the bills reflects the government’s commitment to improve maternity and primary care services. I think it is disappointing that the many positive aspects of these bills, which will make a significant difference to women’s access to midwifery services, have been overshadowed by concerns about homebirth. I will seek to address the issue of homebirth later in my contribution but I want to put on the record early my support for women’s decisions to homebirth. I thank the many women—and, on one occasion, a man—and their children who have come to see me and share their very personal experiences. I understand their concern that some of the provisions of these bills have created an issue with regard to homebirth and that we, as a government, need to continue to work to find a solution.

That said, I want to put it on the record that I absolutely support the extension of midwifery services in these bills. They will improve the health of women and their newborn children, and they give substantial support to women at one of the most wonderful but also challenging times of their lives. I think it is a great credit to the government that it has recognised that and is moving to allow the extension of midwifery services to a whole range of women who have previously not been able to access them. (Quorum formed) These bills improve health services for our community by utilising our highly skilled midwives and nursing practitioners.

This government has come a long way since being elected. We have come a long way in delivering on our election commitment to develop a national plan for maternity services in this country. That is, in essence, what these bills represent. Our processes have been open and transparent. In June 2008, the government called for a review of maternity services. The review received hundreds of submissions. We heard submissions from individuals, health professionals, non-government organisations, academics and others. The entire nation wanted to participate in the consultation process. It is an extremely important issue.

The level of community interest outlined the passion that Australian people have to participate in serious health reform. The report was delivered to the minister in February 2009, and it noted the great quality of our nation’s health system, which can be accessed by women giving birth. But the report noted that there was room for improvement. The report noted that the government could put measures in place to further assist women in need of maternity care.

In response to the review, the government announced $120.5 million for maternity services as part of the last federal budget. The announcement was part of our reforms to the health and hospital system. The package supports the maternity services workforce and assists Australian women with access to greater choices in maternity care. That is what the maternity services reform package is about: giving Australian women choice. We are working to provide Australian women with better access to services and a greater level of flexibility in the health workforce. This package recognises he central role midwives play as part of the birthing process. The package includes the introduction of an indemnity insurance scheme for eligible midwives, MBS and PBS benefits for services provided by those midwives, an expansion of the Medical Specialist Outreach Assistance Program, an increase in scholarships for GPs and midwives to address this critical area of need and a telephone helpline and information service to provide women and their families with an avenue of communication to discuss maternity information.

As part of our reforms we also announced $59.7 million in the 2009-10 budget to fully utilise our highly qualified nursing practitioners. On 24 June the minister introduced these bills into the House for debate in recognition of the importance of addressing long overdue reform in our health system. I support these bills as they allow for the inclusion of midwives and nurse practitioners under the MBS and PBS schemes. The legislation allows for nurse practitioners and appropriately qualified and experienced midwives to request diagnostic imaging and pathology services to be paid for by Medicare. The legislation also allows such nurse practitioners and midwives to prescribe certain medicines on the Pharmaceutical Benefits Scheme. As I have earlier said, even in the face of the global financial crisis this government has put health and hospital reform at the top of its priority list. I would like to commend the minister as she has worked hard since the election to address significant inefficiencies across our health and hospital system. This is certainly a step that will make a significant difference to the many women and families giving birth across this country.

These measures seek to address some of the health workforce issues by utilising the expertise that currently exists among nursing practitioners and midwives. The number of nursing practitioners has steadily grown over recent years, with over 350 currently working across Australia. These highly qualified health professionals have proven crucial across our health system. Midwives play an integral part in our society. They work with women across all communities to give them vital support and professional advice throughout the birthing process, from pregnancy to labour and to post-pregnancy. I want to put on the record my own personal thanks to the midwives who cared for me when I gave birth to my son more than 12 months ago, to the midwives at my obstetrician’s consulting rooms, to Ballarat Health Services, where I chose to give birth, and particularly to Kathy Taylor, who has been a midwife for a very long period of time. As a new mother, and as an older parent, I found the experience a very difficult one, and having a highly experienced midwife helping me throughout the processes, particularly afterwards, was certainly something I valued. I think that every woman should have the opportunity to receive that assistance. I engaged Kathy in a private capacity, and I think that other women would certainly benefit from having more access to maternity care.

I would like to touch on the issue of professional indemnity insurance for eligible midwives and also on the issue of home birthing. Firstly, it is important to note that none of these bills make homebirth unlawful. Despite what is being said by those opposite, none of these bills actually make homebirth unlawful. Instead, these bills deliver greater support for nurse practitioners and midwives—support that will deliver greater choice for Australian women. The separate draft bill, to establish a national registration and accreditation scheme for health professionals, carries a proposal which will require health professionals from the 10 professions covered to carry insurance as a condition of registration.

This draft bill has been developed by COAG and is not yet before any parliament. I think most people who have been involved in either the law or medicine, or who have been consumers, will know that it is really important that any professional have a form of public liability insurance. It is extremely important, as we get into a society that is increasingly litigious, or where things go wrong, that there be an insurance product around and that people be protected by professional indemnity insurance. It is the interaction between the registration and accreditation scheme, the requirement for insurance and the lack of any affordable insurance product for private midwives assisting women to homebirth that has created the difficulty for homebirths. There is nothing inherent in this legislation that makes homebirth unlawful. Whilst it is only a very small proportion of women who choose the option of homebirth, as I stated at the outset this choice is just as valid and important as the birthing choices of women who do not homebirth. I am assured that the government is currently working with the states and territories, and the minister is working with her department, on this issue. It is certainly an issue that I wish to keep a close watch on.

That said, I want to again stress that in these bills the government is providing more choice and options for mothers than any previous government. I think it is unfortunate that the focus has been on the issue of homebirth, almost to the exclusion of the other really terrific things that are in this bill for women giving birth in this country. The whole issue of pregnancy and birth is fraught with politics—it always has been. It is important that this issue be regarded for what it is—it is not a debate about women’s choices versus women’s choices, and it should never be that. It is an issue about how to ensure that we have good access to maternity services across this country for women. The policy intention of the government in undertaking the maternity services review has been to make sure that women do have access to the best possible maternity services. That is what this legislation is about. The issue of homebirth has arisen and the government is seeking to resolve the issue. But the government’s intention in these bills is actually to improve substantially the health of women and their children across the country.

I would like to outline briefly some of the supportive things that other people are saying about this legislation. The Federal Secretary of the Australian Nursing Federation, Ged Kearney, stated:

The government has taken a practical, common sense approach to helping more people get safe, effective health care.

Dr Barbara Vernon, the Executive Officer of the Australian College of Midwives, has stated:

This national legislation recognises for the first time that midwives make a valuable contribution to maternity care in their own right. Evidence confirms that women who receive continuity of care from a known midwife have shorter labours, less need for surgical interventions during birth, reduced rates of admission to special care nursery for their babies, reduced vulnerability to postnatal depression and higher rates of breastfeeding.

I am very proud to be part of a government that for the first time is providing access to the MBS and the Pharmaceutical Benefits Scheme for nurse practitioners and midwives. These bills are not only good news for nurses and midwives; they are also extremely good news for patients. These changes bring to patients equal choice and convenience in terms of their birthing experience. Patients will now be able to receive referrals and tests from qualified midwives and nurse practitioners. This change will dramatically improve our nation’s maternity services system.

I want to briefly reflect on just how fantastic those services are when you have some comparison to the experience of women in countries which are not very far away from us that the Parliamentary Secretary for Pacific Island Affairs, who is here at the table, visited. I acknowledge in my own electorate the work of Zonta and the Ballarat Health Services, who have been putting birthing kits together for a long time now for the women of East Timor. I think if anyone gets an opportunity to go and participate in that experience you will get a pretty short, sharp reminder of just how the birthing experience is for women in the Pacific versus women here.

I think, whilst we are having this debate in this parliament, it is worth reflecting on just how lucky we are to be giving birth in this country. It is fantastic to see increased support being given to women’s birthing experiences in countries who are our neighbours, and certainly we should take the opportunity to thank organisations like Zonta but also to recognise that not everybody’s birthing experiences are as high quality as the medical care that we have here in this country. I just wanted to put that on the record. We are extremely fortunate in this country to have such fantastic access to maternity services. I think the changes that are part of these bills really do put our nation’s maternity services in the top of any in the world. It is a fantastic opportunity for us to have such access, which we have not had previously, to midwifery and nurse services as provided in this bill.

I look forward to the support of my parliamentary colleagues on this side of the House and hope that members opposite can support our nation’s highly skilled nurses and midwives that are represented in these bills. The government has proposed significant changes to the Medicare benefits schedule and the pharmaceutical benefits schedule to utilise our health system at a greater capacity. The government reforms are about providing a health system for the 21st century. These bills go a long way towards achieving this, and I commend them to the House.