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Monday, 7 September 2009
Page: 8712


Ms REA (6:39 PM) —I rise to speak in support of the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009, the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009. I do so with great pleasure because this is probably one of the most significant pieces of health legislation that we have seen coming through this parliament in the last 18 months. Indeed it is an indication, once again, of the Rudd Labor government’s commitment to genuine and serious health reform.

This government was elected on a platform of health reform and it is very clear from many of the announcements made by the Minister for Health and Ageing in recent times—whether it is the report of the National Health and Hospitals Reform Commission; whether it is the report on preventive health or indeed the very significant reforms contained in these pieces of legislation regarding maternity services and the support for nurse practitioners—that the government is committed to honouring its election commitment to see major reform in the health system in order to support and improve the provision of health care to the broader Australian community.

What is important about these particular pieces of legislation is that, first and foremost, they acknowledge the very valuable contribution that midwives and nurse practitioners make in protecting the health of our community and indeed improving health services for individuals in all electorates across the country. This demonstrates that we acknowledge the significant role that health professionals, not just doctors but all health professionals, play in contributing to the improvement of health services in this country. It also demonstrates that we as a government are very strongly interested in focusing more on primary care and preventive health. Indeed I think anyone who talks with the general community, and any of us who talk with our own GPs and with many health professionals and providers within our own electorates, will acknowledge that if we can improve the services of primary care—if we can improve the medical services and allied health services available to those in our communities and in our suburbs—then that is one of the best ways in which we can actually ease the pressure which we all know is on our hospital system. This is not just a question of more dollars; it is a question of where you target those dollars and how you can best provide the health services that will give the best care for those members of our community and that will hopefully prevent people needing to go to hospital in the long term because of the primary care service we are providing.

This particular legislation does that by improving access and options for people—not just within our suburban areas but, most importantly, in regional and rural areas as well—by allowing nurse practitioners and midwives to prescribe certain medicines under the Pharmaceutical Benefits Scheme and to request or provide certain Medicare services, such as diagnostic imaging and pathology services. For midwives this will include antenatal, birthing and postnatal care and collaborative care arrangements with GPs and obstetricians. Of course these services have been argued for for a very long time by many within the health system. I know that, in particular, many nurses, nurse practitioners and those involved in midwifery have been arguing for many years that they should be allowed to have access to the PBS and to Medicare for the services that they provide and that there could be a greater easing of the demands on our health system if they were given the reforms contained in this legislation.

But of course these reforms and changes cannot be introduced without a level of responsibility, scrutiny and accountability when it comes to enabling nurse practitioners and midwives to access these services. For that reason they will, of course, be required to meet certain eligibility requirements in accessing these new arrangements. They will basically be required to be eligible nurse practitioners or eligible midwives as defined under the act. This also applies to those midwives and nurse practitioners wishing to access the government’s professional indemnity scheme, and indeed this legislation also provides for the introduction of professional indemnity insurance. Once again, this is a significant reform, initiated by this government, which will enable midwives and nurse practitioners to provide a greater service to the general community.

Currently, no private insurer offers an indemnity scheme, so the Commonwealth is introducing the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009 that will address this. The Commonwealth will subsidise claims against midwives as follows: 80 per cent of claim costs for those claims between $100,000 and $2 million, and 100 per cent of claim costs for claims over $2 million. It broadly represents the Commonwealth’s existing arrangements for eligible medical practitioners. As we know, there are requirements around eligibility, and midwives will need to be registered in order to take advantage of these reforms.

The bills also improve choices for Australian women when it comes to maternity services in particular. It is, in fact, a key component of the government’s $120.5 million maternity reform package that was introduced in this year’s budget by the health minister. What I think is a particularly interesting part of this package and will indeed address some of the issues raised by the member for Hughes, the previous speaker, when it comes to issues around the availability of obstetricians and professionals in the maternity services area, is that $8 million in this funding package will be spent over four years for two key scholarships. The first will enable 110 eligible GPs to receive up to $40,000 for training to become obstetricians or anaesthetists. As I said, the member for Hughes had already indicated that there is a serious shortage of obstetricians within the country at the moment, and there may well be a number of reasons for that, but I am sure a scholarship of this kind that 110 interested and eligible GPs across the country will be able to access will go a long way to ensuring that there are more obstetricians providing services within the Australian community. On top of that, 20 midwives each year will also gain a two-year scholarship of up to $30,000 to obtain formal qualifications that they need to provide the Medicare services and prescriptions under the PBS as outlined in these bills. This is a significant contribution to ensuring the reforms and the outcomes that we want to achieve as a result of those reforms will come to fruition because we will have the qualified practitioners in place to do so.

I do not think anyone could contribute to the debate on these particular pieces of legislation without acknowledging the statement that came out of the Health Ministers Conference on Friday and the concerns that have been raised by members of the midwifery community and many women who are obviously looking to homebirth as an option for their impending maternity. It is important that we address these issues and that we also address the criticisms that have been raised by the opposition.

As a result of the Health Ministers Conference, a very practical compromise has been reached on this very issue, I believe. Midwives who attend homebirths will have a two-year exemption from requiring insurance to stay registered. This is an issue that has been raised; indeed, many women in my own electorate of Bonner have come to visit me, concerned that they would not have the option of a homebirth if it meant that, as a result of attending homebirths, midwives that they have previously dealt with would not be registered.

They will of course only obtain registration if they do two key things: they must inform the expectant mother that she is not insured for a homebirth and they must also report the birth. I will come back to that matter in a moment because I believe that is one of the key conditions of registration that is very important if we are to address the issues, particularly the insurance issue of homebirth, over the long term. The first thing that we need is accurate data. We do not have that at the moment and this particular condition, as a result of the ministers conference on Friday, will give us the data that we need to address this issue for the long term.

It means that many women, as I said, will have genuine choice. They will have access to homebirths but they will do so informed of the insurance issue when they choose that. It also means, as many members in this place have already indicated, that any fears that homebirthing would go underground or that any dangers that would result from that to both the mother and the child will be addressed and it will not mean that we will see those sorts of activities occurring.

It actually means that the issues that the minister has announced in relation to registration should be applauded because, whilst many will still argue that midwives should have insurance for homebirths, I believe that this two-year exemption is a reasonable and responsible response. I say that because, whilst I, as a mother of three, am very clearly supportive of midwives and indeed of any woman having the right to choose the circumstances under which she wishes to give birth, including homebirth, we do need to be honest about the risks that are out there.

I know that many women undergo quite serious risks even within the hospital environment. I was talking to a constituent only last week who is choosing a homebirth for her third child because of the very unpleasant and difficult experiences that she suffered as a result of going through hospital—not the public hospital system but the private system. She now wants the option of a homebirth.

Nevertheless, we know that there are risks. As I alluded to before, the key thing about understanding those risks is that we actually do not have the data to give us the analysis of the level of risk. We do not actually know how many homebirths there are. We do not know the level of qualifications and skills of the practitioners who are delivering babies in a homebirth situation. I believe it would be irresponsible for us to support an insurance scheme that opened up a Pandora’s box such as this without really understanding what we are actually dealing with.

It is important to remember that we are of course here to administer taxpayers’ money. We have to be responsible about the policies that we initiate when it comes to actually funding insurance schemes such as this. I believe that all practitioners of homebirth—indeed, all midwives—would readily agree that we need to get the data together to understand and develop proper policies and protocols that will ensure women have a choice but one that is safe and also accountable in terms of the spending of taxpayers’ money.

That is why I believe the announcement that came from the health ministers on Friday is a very responsible, very practical one. I think it should be supported by this parliament and the broader community. We know that in two years—the period of the exemption that is being allowed for under the announcement—there will be a national nursing and midwifery board fully operating. We will have the professionals in this particular area operating as a board that will be able to give to this debate the sorts of expertise and guidance that we need. We know, as I have already said, that we will have two years of data collected to understand the needs of midwives who are practising homebirth and providing it for mothers and to understand what level of risk needs to be catered for. We will have an analysis of all of these things which will enable the government to develop protocols, options and good policy around indemnity insurance. It may well mean that in that time there will be private insurance options available; it may mean that the Commonwealth will have to look at a public scheme. But at least we will be able to have that debate and discussion with the information that we need to do it in a practical and responsible manner.

I also say that I welcome the indications from the state ministers, as a result of the announcement last Friday, that they will look at public hospitals being able to work in partnership with midwives to explore options around providing homebirths. I see in the chamber the member for Page, who I understand has in her electorate a hospital that is actually exploring some of those options around the provision of homebirths via the hospital system. A whole range of options will come out of these reforms that will make it so much better for women who are giving birth to do it in the circumstances that best suit them and their child.

I wish to conclude by putting on record my support for midwives and for the option of homebirths. I had three children through the public hospital system. I chose to do that because I support public hospitals and I knew that I would get the best level of care. On all three occasions, it was a midwife who delivered my children; I did not in fact see a GP until after the children were born. It was a great experience, and I want to say on a personal level that having a midwife in the birthing suite with me was certainly a very supportive, comfortable and encouraging environment.

I think that midwives do a wonderful job when it comes to giving birth. We know that historically it has always been the role of midwives. Long before there were obstetricians or medical doctors, it was the women in the community who assisted other women in giving birth. Indeed, the word ‘midwife’ comes from the Middle English word meaning ‘with woman’. It was developed as a result of acknowledging that it was women who were with the women giving birth. The word dates back to about the year 1300. We know that midwives had existed for many, many centuries before that. It is important that, nearly 709 years since the word came into existence, we now have legislation which acknowledges very clearly the important role that midwives play when it comes to giving birth, that they are a genuine option for many, many women and that they support and nurture women when they are going through that amazing experience of giving birth—an experience terrifying and amazing at the same time. For that reason, I am very proud to support this set of bills, and I encourage everyone in this parliament to do so.