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Monday, 7 September 2009
Page: 8645


Mr CHEESEMAN (1:46 PM) —I welcome the opportunity to speak on the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and cognate bills. Having become a father recently, these are issues that I have given considerable thought to. It is great to see the government bringing some improved clarity and science to these issues, particularly to homebirthing and related insurance matters. It is also nice to be speaking on an issue that is at the leading edge of the delivery of health services across Australia, particularly the issue of nurse practitioners. I congratulate the Minister for Health and Ageing on these bills. Minister Roxon has shown a lot of resolve to deliver a greater level of certainty to the midwifery area and even more nerve to ensure that the rollout of nurse practitioners happens in a meaningful way. I cannot understate the importance of the role that nurse practitioners will play in the reform process in the delivery of health services right across Australia. This is indeed a very important change. In future years I think history will show that this reform was one of the most fundamental and important changes in our healthcare system.

Almost always when we make major change there is a push back within some elements of the community. The minister has stood up to this. I listened to the comments and the pressure put on by the various stakeholders in this debate. It was a real test that was passed with flying colours by the federal minister, who has taken the initiative in Victoria and nationally with these health reform bills. There are currently around 350 qualified nurse practitioners in Australia, generally working in public hospitals. I believe the role of nurse practitioners is a terrific one. It provides an important level of care, more flexibility and better integrated healthcare outcomes with our healthcare workforce. It also provides a fantastic new element to the nursing career structures and I think it will help contain costs within the Australian healthcare system. Nurse practitioners can already provide healthcare services and prescribe medications in the majority of jurisdictions around the world. However, the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill will enable their clients to access the Medicare benefits schedule and Pharmaceutical Benefits Scheme subsidised services and medications. In the budget, the government committed $120.5 million over four years to maternity services reform and $59.7 million over four years to expand the role of nurse practitioners. This bill is delivering on that commitment. These bills will support the inclusion of nurse practitioners and midwives under the MBS and PBS in line with the 2009-10 budget measures. In addition to these bills helping to drive the nurse practitioners reform issue, they will also enable the establishment of a professional indemnity scheme for eligible midwives. This is critical in supporting the new MBS and PBS arrangements that we have spelt out. The midwives and nurse practitioners bill will allow for nurse practitioners and advanced midwives to request or provide specific Medicare subsidised services and prescribe certain PBS subsidised medicines.

New Medicare items covering these services will also be introduced, effective from 1 November 2010. I think there is an important point to make in how the new arrangements will work. What we are seeking to put in place is a more effective and appropriate healthcare delivery structure that has all the proper checks and balances. Importantly, for midwives to be eligible to participate in the new arrangements they will need to meet advanced practice requirements and they will also have to work in collaborative arrangements with doctors. The minister and the Department of Health and Ageing will be working through exactly what is required and a comprehensive consultation process with midwives, doctors and other stakeholders will take place. The reform initiatives supported by this legislation will allow for incremental reform within a strong framework of quality and safety. It is expected that around 700 eligible midwives will be participating in the measure over the coming four years.

I want to go through a few details in relation to the professional indemnity for eligible midwives and, of course, to deal with the homebirthing issue. The three bills before the House improve choice and extend Commonwealth funding for a range of midwife and nurse practitioner services for the first time ever, including the provision of antenatal care in the community and attending births in clinical settings. But, very importantly, none of these bills make homebirth unlawful.

As we know, there is still a strong homebirth movement in Australia. Many Australian women and their families still take up this option. There are many women and men who favour homebirthing over the more clinical settings of hospitals. It is very important that in designing the new laws, the overall framework for midwifery, there are still choices available to women. We do not in any way want to establish a framework that makes homebirthing illegal or that drives it underground. That would be an absolute disaster in my view and most certainly might end in tragedy.

To avoid this, the Minister for Health and Ageing, after considerable consultation with state governments, has forged an agreement with all healthcare ministers around the country to add a transitional clause to the current draft national registration and accreditation scheme legislation. This transitional clause provides a two-year exemption for privately practising midwives who are currently unable to obtain professional indemnity. This clause will allow midwives who are currently practising to continue to do so, although they of course will not be insured. As most people are aware, there are currently no professional indemnity health products available for midwives working outside the state hospital system.

There are a couple of other important aspects to these bills that I think are very positive. These bills will improve disclosure and provide better information on services for users; provide better systems for collection of data, which will form the basis of future research so that we can continually refine and improve services; and provide better overall health standards systems for us to use. There will also be a requirement for homebirthing midwives to disclose fully to clients that they do not have professional indemnity insurance so that people can give informed consent. This is important and will ensure that clients are better informed about their rights and legal standing should things go wrong.

As well, each homebirth must be reported and disclosed. This is important because, in the past, the recording of data about homebirths has not been as good as what it should or could have been. There have previously been no reporting requirements. People will also be required to participate in a quality and safety framework which will be developed after consultation led by Victoria through the finalisation of the registration and accreditation process. We will, for example, ask the national Nursing and Midwifery Council to provide advice on protocols for homebirthing outside the publicly funded and auspiced services.

Importantly, the collection of better data on homebirthing and the development of detailed protocols might actually bring more homebirthing services into our public system or potentially open the way into the future for an insurance product to be extended to cover them. Of course, we will have a fully operational nursing and midwifery board in place as a part of the changes that are established as a result of the registration and accreditation. So there are multiple benefits that are going to be introduced as a consequence of these bills. We are clearing up things that the previous government never got to. This has been achieved with a determined effort by the federal minister and with all governments working together to obtain an outcome that is progressive for our healthcare system.

Overall, the three bills before the House expand Commonwealth support for midwives and nurse practitioners in our community. They improve choice and extend Commonwealth funding for a range of midwife and nurse practitioner services for the first time ever, including providing antenatal care in the community and attending births in clinical settings. I underline again: none of these bills make homebirth unlawful. In fact, I believe they put in place foundations that may well lead to services of a sustainable nature with a long-term future.

The separate draft bill for the National Registration and Accreditation Scheme for the Health Professions currently carries a proposal that will require health professionals from the 10 professions covered to carry insurance as a condition of registration. This draft bill was prepared for all jurisdictions via a COAG agreement and is not yet before any parliament, but the bill goes hand in hand with some of the provisions of these bills and is another element in standardising accreditation requirements and a universally better healthcare system.

I think this legislation is very positive for my electorate. These measures will help improve the efficiency, capacity and productivity of Australia’s health workforce, but they are particularly important in rural and remote areas. As we know, many regional and rural areas struggle for GP services, and women giving birth sometimes have to travel a long way from their homes and their home communities. Whilst my electorate has recently taken some enormous strides in health service provisions under the Rudd government, as we build capacity at Deakin University’s medical school and provide a regional GP superclinic, there are still areas where it is hard to see a doctor or to get appropriate healthcare services when you need them.

These changes will help alleviate that problem. These changes will mean more people will be able to get timely medical advice when they most need it. These changes support the Commonwealth’s commitment to improve maternity and primary care services and they support the Council of Australian Governments health workforce reform agenda. These changes will also lift the standard of health care that people get in regional Australia. I commend the minister for her hard work and for her compassion in this area, and I commend these bills to the House.


The SPEAKER —Order! It being approximately 2 pm, the debate is interrupted in accordance with standing order 97. The debate may be resumed at a later hour.