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Thursday, 20 August 2009
Page: 8530


Ms JACKSON (1:27 PM) —I am delighted to speak in support of the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and two related bills, all of which concern midwives and nurse practitioners. These are three progressive pieces of legislation which in my view go beyond tinkering at the edges to genuinely reforming our health system, which the Labor government has recognised is at a tipping point.

Before dealing with the specifics of the legislation, I would like to say I am absolutely delighted with some of the federal government initiatives that we have seen in the health portfolio. Last December we saw $64 billion in the new health and hospitals agreement signed with the states. We have also seen the recent report of the Health and Hospitals Reform Commission, and I look forward to participating in discussions in my electorate regarding its recommendations. We have also had community consultations in my electorate regarding, in particular, the establishment of a GP superclinic, and I am pleased to say that the Minister for Health and Ageing has indicated that we can expect a decision on that soon.

There is also intended to be consultation on the Health and Hospitals Reform Commission recommendations at the Swan District Hospital at Midland in my electorate. We will be very pleased to welcome that discussion at our local hospital. I was also delighted with the announcement in this year’s budget of some $180.1 million of Commonwealth money going towards building a new Midland Health Campus in my electorate, a facility that is long overdue and that will ensure many more patients in my electorate get access to acute levels of care. I look forward to working with not only the Commonwealth government but also the state government and my local government in the City of Swan to see the Midland Health Campus come to fruition hopefully no later than 2013.

I have some wonderful healthcare professionals in Hasluck many of whom have been very supportive of these reforms and of this particular legislation. They provide wonderful care to our community from cradle to grave. In particular, I refer to the Division of General Practice in my electorate, the Perth Primary Care Network, formerly the Perth and Hills Division of General Practice, and also to a particular practice in the suburb of Midland, the Swan Medical Group. These organisations have been in advance of many others in their profession in supporting, recognising and acknowledging the role of nurse practitioners. Indeed, they run very efficient and responsive practices in my electorate already using the professional wisdom and competency of nurse practitioners. They were early advocates for nurse practitioners and I know that they join with me in being very pleased to see this legislation put before the Australian parliament. I know how stretched some of their resources are. Sometimes, unless you are prepared to wait, it is difficult to get an appointment. Nurse practitioners are part of a strategy of ensuring that there is better access to those primary care services in my electorate.

At a personal level I am delighted to see this legislation come to fruition. I was involved in the mid-1980s in discussions in my home state of Western Australia regarding the transfer of nurse education from the hospital sector to the territory sector. That was a very important move in recognising the complexity of their work and the high level of tertiary knowledge required by our registered and enrolled nurses to practise competently in our hospitals and healthcare settings. That is 20-odd years ago now and in those days nurses were often faced with very heavy stereotypes and were, frankly, treated in some cases as the handmaidens of general practitioners and doctors in our healthcare system. I am very glad to have seen the changes in attitudes that have developed over the past 20 years.

Unfortunately, some of those stereotypes have not changed with respect to the fixing of nurses’ wages and conditions. Whilst again I acknowledge that we have come a long way in those 20 years, we are still a long way short of pay equity for nurses in all of their capacities. The ones closest to my heart are enrolled nurses who have an associate diploma and perform a very vital role in our healthcare system. They are often not recognised for their highly skilled contribution to health care. I have been very closely involved with this profession for over 20 years and it is with great pride that I speak in favour of this legislation which will empower midwives and nurse practitioners to operate as professionals in their own right and to provide the best health care to Australian communities.

This legislation has received wide-ranging support. It has support from the Australian Medical Association, the Australian College of Midwives, the Australian College of Nurse Practitioners and various associations of healthcare professionals. It is receiving this support because it facilitates a collaborative model allowing the right healthcare professional to provide the health care needed. It is important to understand that these bills do not change the existing abilities through state and territory legislation for nurse practitioners to prescribe medication or to refer patients. Nurse practitioners are already able to do this and, to a varying extent in the state public health systems, they are in fact doing this. What is proposed is to confer access to services itemised under the Medicare Benefits Schedule and to confer authority to prescribe certain medicines under the Pharmaceutical Benefits Scheme.

I had the privilege of meeting recently with a nurse practitioner in my electorate of Hasluck. He is one of two practising in the emergency department at the Swan District Hospital located in the suburb of Middle Swan. He is understandably passionate about the value that the role of nurse practitioners brings to our health system. He is currently in a position where he can make referrals and write prescriptions for medication autonomously within the public health system. He makes assessments based on his high level of skill and his experience in the nursing profession. At present, he sometimes identifies the need to refer a patient to a private professional or to a specialist, such as a maxillofacial surgeon, or to prescribe medication for the patient to obtain from a pharmacy. Despite this coming within the scope of his training and experience, he still must find a doctor in the emergency department to provide the necessary documentation. In essence, the immediate ramifications of this legislation for him and his role now will merely make those processes less complicated and give him the professional recognition that he deserves. I am proud to say that these changes are consistent with the Labor Party platform where we indicated again at our recent national conference—(Quorum formed) I thank my colleagues. It is one of the small prices we pay for government and it is a pleasure to be in government. Thank you for popping in and listening to what I have to say on this legislation. I was talking about a nurse practitioner in my electorate of Hasluck, Robin Moon, who I am very pleased to say will see the immediate ramifications of this legislation for him in his role in the emergency department at Swan District Hospital Campus and also give him the professional recognition that he deserves. Unfortunately, in Western Australia it has taken some three years for Robin after he qualified as a nurse practitioner to be able to convince his employing hospital that there was a role for nurse practitioners within the hospital emergency department.

This is still a problem across my home state of Western Australia. We estimate that there are some 85 nursing practitioners currently registered, but around only 30 of those are working and recognised as nurse practitioners. This, in my view, is a great waste of a highly skilled and competent workforce and I encourage the Western Australian government to address this situation at the earliest opportunity.

We have seen a much more progressive attitude in the private sector in Western Australia where the benefits of this legislation will also be immediately utilised. The private sector in Western Australia is poised and ready to deliver community health care to Western Australians in ways that have never been imagined before. I have one large charitable organisation in Western Australia which is currently examining the concept of providing home services which are a virtual hospital. They can employ nurse practitioners and other health professionals to go out into patients’ homes and provide Medicare subsidised elements of health care ordinarily available only in hospitals. We know that that will have some distinct advantages in assisting people to remain in their own homes. Most of us prefer to be at home than to be admitted to hospital.

Another very exciting example of progressive change in health care in WA is shopfront health care. Appearing in WA shopping centres are what we call ‘revive’ clinics, which are staffed by nurse practitioners to treat minor illnesses, including being able to provide prescriptions for medications such as antibiotics where necessary and to provide coaching in areas such as weight loss or in assisting with stopping smoking. In country and regional areas such as Port Hedland in the Pilbara of Western Australia where there are some four doctors available to service the population, the ability of nurse practitioners to access Medicare when operating from such clinics will enable them to fill a critical gap in the provision of health care, especially in areas such as immunisation.

On the broader front of training these professionals, I am pleased that the government has recognised the need to invest in training for the future and that the government has already announced funding of $2.1 million to develop our nurse practitioner workforce. We have provided access to scholarships for up to $15,000 per annum for the two-year masters degree that it is necessary for nurse practitioners to undertake to get their qualification and recognition. I believe that when the WA state government finally starts utilising this resource we in the Commonwealth at least are ensuring that nurse practitioners will be ready, willing and available to fill this need.

I want to talk briefly about midwives. I am a great supporter of midwives and have had the pleasure of being part of the birthing team when my sister gave birth to her four beautiful children. These births occurred in the birthing centre at King Edward Memorial Hospital, a fine facility which is staffed entirely by midwives. My sister created the record for being the first person to have her four children in the birthing centre. My lovely nieces Lauren, Jessica, Emily and Amy were all delivered by a wonderful and competent team of midwives at the King Edward Memorial Hospital birthing centre, and I pay tribute to them. What a fantastic experience it was to be a party to their births.

For those of you who have been around at the birthing of children, I truly believe it is evidence that there is still magic in the universe and you will never forget that first breath that a baby takes upon being born. Being the stepmother of two children myself, I disappointed my mother when she asked me after I had been through this wonderful experience if I intended to have my own, to which I responded: ‘My goodness! Not now that I’ve seen where it all comes from.’ Nevertheless, it was a beautiful experience and I am honoured to have been party to it.

These bills will enable health professionals, midwives and nurse practitioners to work collaboratively with obstetricians and hospitals by giving them independent access to the relevant Medicare items and Pharmaceutical Benefits Scheme and addressing the market failure in indemnity insurance for these people. Currently, midwives have been unable to obtain professional indemnity cover for midwife-led birthing as opposed to obstetrician-led birthing, despite estimates by the Australian Government Actuary that the incidence of claims is likely to be comparable to that of obstetricians and procedural GPs.

This bill establishes a system whereby a private insurer will be able to offer a suitable professional indemnity product, with the Commonwealth assuming responsibility for a substantial part of the liability. I know that those opposite have criticised the legislation because it does not extend at this stage to supporting Medicare or PBS funding for homebirths. Can I say to those members present that none of these bills makes homebirths unlawful and none of these bills changes the current arrangement with respect to homebirths as they have always been. These three bills form part of the maternity services budget package. The Commonwealth is committed to underwriting midwives insurance to enable such an insurance product to be developed. I reiterate that we all look forward to seeing this come to fruition—


Mr Laming interjecting


The DEPUTY SPEAKER (Ms AE Burke)—Order! The member for Bowman will have his chance later.


Ms JACKSON —The Commonwealth had not intended that this new product would be feasible or affordable if it included homebirthing. I know this causes significant and wide concern among some people, but we know that the minister is working hard on this issue, through her department and with the states and territories, to bring about a result which will see that professional indemnity cover eventually applied to midwives and homebirths.

I note the comments from members opposite, who held government for 12 long years and, in all that time, did nothing about the professional recognition or training of nurse practitioners—and I caution the member for Bowman in that regard. These are progressive pieces of legislation welcomed by professional nurse practitioners around Australia. I congratulate the minister on her legislation.

Debate (on motion by Mr Kerr) adjourned.