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Monday, 7 September 2009
Page: 8621


Mr BRIGGS (12:03 PM) —Thank you, Mr Speaker. It is a rare occasion that the Speaker is in the chair when I am on my feet. It will give me great pleasure to speak while you are here. We are debating today important legislation which covers several areas. Most contentious of course is how it has dealt with midwives and homebirths, and as I am the first speaker to deal with the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and related bills since the minister’s backflip on Friday I will be able to make some remarks on that. But firstly I will deal another aspect of the bill, the PBS and MBS access for midwives and nurse practitioners, which is included as part of the Maternity Services Review which this government has undertaken. It is one of the many hundreds of reviews that the government has held since it came to office, particularly in the area of health, where it has had more reviews than days in office so far.

The coalition’s view is that there needs to be a more holistic approach to health care in Australia, especially in the areas of preventative health and chronic illness. The skills of all health and medical practitioners should be utilised to their full potential and in accordance with appropriate scope of practice. It is important that PBS and MBS access for all professionals is carefully restricted and monitored in accordance with professional qualifications and experience. Of course we are very fortunate in Australia to have a high-quality healthcare system. It has its challenges, particularly with state-run public hospitals. There are many challenges in all states at the moment, particularly in my home state of South Australia, and in regional areas such as mine it is a very challenging area of government policy, one where the state governments are clearly not up to the task. I note that the Rudd government, since coming to office and prior to being elected, have promised that if the states do not achieve certain benchmarks or certain standards they will take a full takeover of the health system to the Australian people. Whether that is the right or wrong approach, it will be dealt with at some other time; however, it is worth noting that their approach to that promise has been reduced since they have come to government and realised how challenging this area of policy is. The buck appears not to have stopped anywhere.


Ms Hall interjecting


Mr BRIGGS —The member for Shortland is garbling something. It is important that there be appropriate guidelines for scope of practice ensuring patient health and the economic viability of the PBS and the MBS. Referral rights for nurse practitioners to specialise may give rise to inefficiencies. Currently, GPs refer only a very small portion of patients to specialists and are best placed to make such decisions.

While highlighting some of these concerns, the coalition will not oppose this legislation. We firmly believe that GPs are the cornerstone of primary care in Australia and it is important that there is genuine collaboration between other health professionals and GPs in managing patient health care. That is a fair summary of our position, a position that the shadow minister has pursued with some vigour since he took on that role. It is a position which is important particularly in outer suburban and regional areas such as mine, where there is limited access for people to medical services in some cases. There has been a centralisation of health services over many years, and there are challenges for regional health across this country in ensuring that people have access to appropriate healthcare services for both preventative and reactive health care.

We in the opposition are supportive of the government looking at these issues, but we do think it is getting to a point where the government need to start taking some action to fulfil some of the promises they made—which is, of course, what they are meant to do. When it comes to healthcare services in Australia, when the government promise that the buck will stop with them and they do not fulfil that promise, people have every right to be disappointed. The realm of health services also includes the aged-care sector, which in my electorate and also across a range of electorates around the country faces significant challenges.

That brings me to the other and more contentious aspect of this legislation, which is at the other end of the healthcare services spectrum, and that is homebirth. I think it is a disgrace that the government have handled homebirth in the way they have in this legislation. They are reducing choices for women. Not long ago I actually wrote a blog for The Punch about the whole issue of birthing and government putting its nose where it is not welcome. I suspect that is the best way to describe it. My wife and I were fortunate, with both of our children, in having very safe and happy births. We used a private obstetrician for both of them, and the services were first class. It is always very saddening to hear about stories of births that do not go so well, and it is a credit to the medical profession that, in the modern day, the rates of infant mortality are so much lower than they used to be. However, as a parliament I think we need to realise that birthing is a very personal and individual experience. For my wife and I, it was a very deep experience with the babies, and I think it is dangerous when governments start to intervene and restrict how that experience can be conducted, and that is exactly what this legislation seeks to do.

On Friday, the Minister for Health and Ageing performed a backflip, and she is seemingly allowing two more years for consideration of the homebirthing issue. I suspect that it is more of a bureaucratic battle with the health department and insurance rather than the actual health aspects of homebirthing, given that state governments run homebirthing services already. I suspect it is more the insurance angle, rather than the health aspects, that the government is trying to grapple with. I think that creates a very unfortunate situation, where the government has tried to outlaw something—by putting a significant fine on it and therefore outlawing it—because, it appears, it is beyond their wit to deal with what is mainly an insurance issue. As I said in the blog that I wrote in The Punch, it is a very poor excuse to send something underground, which is in effect what will happen, because there are a group of people in our community, even though it is a small percentage—


Ms Hall interjecting


Mr BRIGGS —Currently it is able to, Jill. The member for Shortland says that is what the problem is currently. What your health minister has done in this legislation, Member for Shortland, is to try and make homebirths illegal. The Labor Party believe that government knows best and you can tell that to all the people out the front of Parliament House who have come here today to protest—the people the Labor Party will ignore, at their peril. Ultimately the individual knows best. Birthing is a very personal thing, and if the Labor Party try to tell women of Australia how they are going to do it, they will find that it is not a very practical or popular decision in the long run.


Ms Hall interjecting


The SPEAKER —Order! I remind the member for Shortland that, as of yet, there are no interventions in this House. Even though that might lead to a better debate—and I am sure the member for Mayo would be able to handle interventions—at this point in time it is not allowed. The member for Mayo has the call.


Mr BRIGGS —It is, I think, a good indication of the nervousness or the sensitivities on the other side to this issue, given the minister’s decision on Friday.


Mr Bidgood interjecting


Mr BRIGGS —It would be interesting to know whether the member for camera shots on the other side, who interjects, went to the rally at the front of Parliament House earlier to explain to his constituents


Mr Bidgood —I know more about homebirths than you’ll ever know.


Mr BRIGGS —I am sure you do. You have probably taken some photos of it.


The SPEAKER —Order! The member for Mayo will ignore the interjections. The member for Mayo will speak to the bills.


Mr BRIGGS —Thank you, Mr Speaker, for bringing me back to the legislation. Homebirth is a very personal issue and, as I said earlier, my wife and I were very fortunate. We have had two—and my wife plans more—birthing experiences which were very fortunately positive, and we are very lucky. However, others do not have such positive experiences, and they do need the best care available. There is no doubt about that. However, to rule out access to homebirths altogether rather than dealing with an insurance issue was an ill-thought-through decision. I am very pleased that the minister has listened to the concerns. She has undertaken a backflip for a two-year period, and we hope that in that time she will be able to get her mind across how to deal with the insurance issue.

I must say that this is probably the biggest issue which has driven contact to my office since I was elected 12 months ago. We have had more correspondence and contact about this issue than about any other single issue. It is a small group of people who are involved, but they are very passionate about their right to choose. That is something that we on this side of the House support. We support women’s right to choose. It was unfortunate that the government decided not to support that right of choice. We have fought against that and we are very pleased that the minister has seen it appropriate at this point to backflip for a two-year period. We hope that in that time she will be able to get across a better way to deal with the issue of homebirths and the issue of insurance, which is attached to it, and we certainly will have more to say as far as our policy going forward.

I thought I would give a snapshot of the emotion which is attached to this issue. A constituent of mine, Amy Sparshott, wrote to me again on Friday—she has written a couple of times. I think she describes the issue very well. She says:

Homebirth is not something that many women choose for themselves; however, it is important that women continue to have access to this choice of care. The South Australian state funded homebirth programs run from hospitals are a start but are not accessible to most South Australian women due to the strict guidelines and small geographical catchment areas.

My electorate of Mayo is not covered at all. The letter continues:

Midwives in private practice are experts in normal birth. Their skills will be lost once they either cease to work as midwives or find they have to work within a hospital system that is geared towards finding complications and introducing interventions during labour and birth that are not often needed.

That brings me to another reason for homebirths. There is, of course, choice but there is also circumstance. A couple of the ladies who have come to see me about this issue have said that they would never go back to a public hospital because of the experiences they had. So the government can slap a $33,000 fine on this and ban it outright—as the member for Shortland appears to want—but that will push these births underground and it will reduce access to the high-quality professionals that these people need, because they are going to do it anyway. Some will argue, ‘That is not taking much care of the unborn baby,’ but I do not think that is a fair characterisation of what these mothers and fathers are going through. The experiences they had in these public hospitals were so horrific that I can understand why they do not want to go back. It is only right and fair that they be able to choose another option which suits their needs better.

This is a very private and personal experience. It is a very important experience that many of us go through and enjoy. To tell someone that they cannot do it their chosen way because of an insurance issue is weak. It is right that the minister has backflipped, and we hope that she continues to. I support the sentiments of what Amy Sparshott, Joe Woods and others who have come to see me have said. It is about choice, but it is about choice for their reasons—whether it be the experience they have had previously in a public hospital or whether it be that they feel more comfortable to give birth in the home environment, it should be their choice.

The issue of care and responsibility for the unborn child raises its head in this debate. The situation is that homebirthing is not for everybody and few people choose it. There is no doubt that there are certain cases where homebirthing should not be undertaken—on medical advice—but I defy anyone to tell me that mothers and fathers would deliberately put their unborn babies at risk. It is quite an accusation to suggest that people would willingly put their unborn babies at risk and not think through the consequences.

We are very pleased that we have been able to get the minister to back down from the original intention of the bill, which was to outlaw homebirthing. It is as clear as day that slapping a $33,000 fine on midwives for assisting with homebirthing clearly rules that out as a possible option. We are glad that the government have backed down on that, because it would have sent homebirths underground, it would have reduced choice and it would have been a negative move for females in this country. We stand on the side of choice. We stand on the side of females being able to choose the healthiest and most appropriate way for them to give birth. We are glad the minister has backed down so far on this and we hope that she goes even further.