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Monday, 7 September 2009
Page: 8625


Ms HALL (12:19 PM) —I would like to commence my contribution to this debate on the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and related bills by providing the member for Mayo with some information that might help him, so that next time that he makes a speech he can actually put factually correct information to the House. I have in my hand a letter from one of my constituents who wrote to a local health fund. This constituent is a midwife and is a person who is very supportive of homebirthing and somebody I have had a long association with. She wrote to a health fund asking them why they had removed homebirthing from the schedule that they paid insurance rebates for. Oh, the member for Mayo has left the chamber. He did not want to learn or get the information that showed that what he presented to this House was factually incorrect. The letter reads:

Thank you for your response to my inquiry. You have stated that the removal of the homebirth benefit is due to the fact that midwives in private practice are unable to source professional indemnity insurance for the homebirth of a baby.

And this is the really key point—

This has been the case since 1 July 2001.

Who was in government then? That has been the case since 1 July 2001, when those opposite were in government. Those on the other side argue that they have supported homebirths for a long period of time—so how could it be that it was removed from medical indemnity insurance when they were in government? I find it sickening to see those on the other side of this House standing up and advocating homebirthing when they were the ones who removed it from medical indemnity insurance. They have never supported choice for women. They have always adopted a very patriarchal approach to birthing and other women’s health issues, where they feel that they have the right to tell women what they need and what is best for them. I hear speaker after speaker after speaker stand up and advocate homebirth, and that is really out of character for those on the other side of the House.

I have been associated with midwives in my electorate for a very long time. I have attended picnics on the foreshore in Newcastle with midwives where they advocated homebirthing, and I stated my support for homebirthing in that environment. It was many, many years ago—around 2001, I believe—when the then government decided that they would not offer medical indemnity insurance for midwives.

Listeners to this debate could actually be confused as to what it is about. They could think that this was a debate about homebirthing; that is not true. This is an excellent piece of legislation that supports the inclusion of nurse practitioners and appropriately qualified midwives under the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme in line with the 2009-10 budget measures. This will enable these health professionals to request appropriate diagnostic imaging and pathology services for which Medicare benefits may be paid and to prescribe certain medicines under the PBS. The MBS and PBS benefits will be available from 2010.

The professional indemnity, which has been discussed at great length and which I will come back to in a moment, will commence on 1 July 2010. Medicare benefits and PBS subsidised medicines will not be approved for delivery outside of clinical settings. The Commonwealth subsidised professional indemnity cover will not respond to homebirthing but, as has already been said in the debate today, an agreement was reached at the COAG meeting on Friday.

I heard the previous speaker refer to ‘backflips’. I would like to refer him, and all those members on the other side of this House who are not in the House now, to statements made by the minister consistently through this debate that there were negotiations taking place between the states and the Commonwealth and that this matter would be resolved. I refer to the communique that was released on Friday, which says:

Health Ministers agreed to a transitional clause in the current draft National Registration and Accreditation Scheme legislation which provides a two year exemption until June 2012 from holding indemnity insurance for privately practising midwives who are unable to obtain professional indemnity insurance for attending a homebirth.

That is a far cry from what happened in 2001, when the Howard government removed that coverage from midwives. Professional indemnity insurance for midwives has always been quite an issue. I refer to the paper I have in my hand, from Australian and New Zealand Health Policy, which discusses the issue at great length—how Australian governments, particularly the Howard government, I have to say, appeared reluctant to protect the economic viability of the business of self-employed midwives. This legislation does give some protection to midwives, as does the agreement that was reached on Friday.

The government has committed $120.5 million over four years to maternity service reforms and $59.7 million over four years to expand the role of nurse practitioners. I might add that those on the other side of this House have always opposed the expansion of nurse practitioners. As a member of the House of Representatives Standing Committee on Health and Ageing over a very long period of time, I have seen many members on that side argue that nurse practitioners take away from the role of doctors. Last week I was in the Torres Strait Islands with the health and ageing committee and we visited Saibai, which is nearly the northernmost tip of Australia. There we saw firsthand just how vital the role of a nurse practitioner is, how essential it is for nurses working in very remote and rural locations to be able to work as nurse practitioners. They are delivering front-line services with doctors, hundreds or thousands of kilometres from where their health clinics are. That is the case in many areas throughout Australia. Mr Deputy Speaker—sorry, Mr Speaker; it is such an honour to have you in the chair.


The SPEAKER —I am not sure where this flattery is going, but the member for Shortland will continue speaking to the bill.


Ms HALL —Thank you, Mr Speaker. I have been a member of the health and ageing committee, as I mentioned, for some period of time. I was deputy chair when we brought down the report The blame game: report on the inquiry into health funding. When we did that inquiry, we looked extensively into the role of midwives and nurse practitioners. It has been my long-held belief that legislation like the bill we are discussing and debating here in this House today was needed. I did not see any moves from the then Howard government to act on those recommendations or to address that need.

In 2007 I was a member of the committee and we did an inquiry into the health benefits of breastfeeding, called The best start: report on the inquiry into the health benefits of breastfeeding. That inquiry really emphasised to me the vital role that midwives play, how their role needs to be expanded and how they need to have the rights that are being given to them in the legislation that we are debating here in the House today. It is a midwife who provides the support to a mother during pregnancy. Obviously, there is a very important role for obstetricians, but some women choose to have only a midwife’s support. After the birth is when a midwife provides the particular support that is needed in relation to breastfeeding. To hear those on the other side of this House sanctimoniously stand up and make the case that they support choice, they support midwives and they support women really turns my stomach.

I will get back to the legislation. This bill will support the inclusion of nurse practitioners and midwives under the Medicare Benefits Scheme and the Pharmaceutical Benefits Scheme, which is particularly important for those midwives who work in remote locations like Saibai Island and Thursday Island, as I mentioned earlier. These measures will help improve the efficiency, capacity and productivity of Australia’s health workforce, particularly in rural and remote areas, and it will make it so much easier for those nurse practitioners and midwives working in remote communities. When I was at Saibai Island last week, the nurse practitioner midwife there said that within the last month she had been required to assist in the birth of three babies whose mothers had come across from the Western Province of Papua New Guinea. Those births can be extremely difficult, and in those cases the excellent, highly qualified midwife can provide the assistance that is needed until the medical assistance of an obstetrician can be brought in.

These measures are vitally important for improving primary and maternal care. This legislation will allow nurse practitioners and advanced midwives to work in collaboration with doctors. I use Saibai Island in the Torres Strait as a very good example of where the skills of these midwives will be utilised. The new Medicare items covering these services will also be introduced, effective 2010. Specific Medicare items as well as PBS formulas specifying midwives and nurse practitioners will be managed through the minister’s determination. At this stage the government is not supporting funding of homebirthing. I have already referred to the communique that was released, and I can also refer to the transcript of the minister’s press conference on Friday, where she highlighted that there had been a breakthrough in the national registration and accreditation program. This has led to the resolution of the homebirthing issue. I hear people like the member for Mayo getting up and saying it is a backflip. It is not; it is the result of a lot of hard effort put in by the minister, who has worked constructively with the state health ministers to bring about a situation where this can take place. The Commonwealth signing on to the registration of the accreditation of 10 professions is about lifting standards, as the minister said. That is what it is all about.

I think this legislation has the ability to change the way nurse practitioners work. I should emphasise that, though I have talked a lot about those nurse practitioners working on Saibai Island, to a large extent it refers to nurse practitioners and midwives working in private practice. I felt the example of Saibai Island really showed how effective it was on the ground. In many areas throughout Australia there are no doctors on the ground. The simple fact that there are qualified midwives in those locations can really provide support that is needed. These midwives will need to meet advanced practice requirements and have collaborative arrangements with doctors. This is all about providing and ensuring the safety of those women who are giving birth and of their babies.

The reforms initiative supported by this legislation will allow for incremental reform with a strong framework of quality and safety. Quality, safety and being able to choose to have midwives and nurse practitioners when the time is right are what the Australian people should expect. It is expected that about 700 eligible midwives will participate in the measure over the next four years, so that will significantly expand the workforce and provide a lot of support to women throughout Australia. I have to emphasise that none of these bills have ever sought to make homebirthing unlawful—


Mr Ian Macfarlane —That’s not right, is it?


Ms HALL —yet those people on the other side of this House have said these bills are about making homebirthing illegal. Unlike the Howard government, we have not removed that professional indemnity that was in place.

I have to refer back, for the member who is going to speak following me, the member for Groom, to the fact that midwives not having medical indemnity insurance has been the case since 1 July 2001. What government was in power then? The Howard government. A large number of members on the other side of this House were members of the Howard government and I presume they supported that move, and now they sanctimoniously stand up in this parliament and argue that choice is being taken away by this legislation when in actual fact, through the hard work and the strong negotiating skills of the minister, we are in a situation where for the next two years there will be medical indemnity insurance. An agreement was reached on Friday and ongoing discussions will take place from there.

I would really like to congratulate the minister. This is groundbreaking legislation. This is legislation that does support choice for women. It is legislation that is not about telling women what they have to do but rather about providing choice. It is about recognising both nurse practitioners and midwives, and acknowledging that they have a significant contribution to make to our health system. I commend the bills to the House.