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Tuesday, 8 September 2009
Page: 8928


Mr MURPHY (5:46 PM) —I rise this evening to speak in this place on 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 would like to begin by acknowledging the enormous contribution that all our allied health professionals have made to the quality of care in Australia, and I also take this opportunity to thank them for their outstanding efforts. Our health and medical professionals have ensured that Australia is one of the safest countries in which to give birth and, indeed, in which to be born. However, I also acknowledge the shortages we are currently experiencing in our medical workforce and the need for increased access to essential services with medical professionals, particularly in remote and regional areas. That is why our Minister for Health and Ageing, Nicola Roxon, has introduced these bills that support greater choice and access to health services. The bills aim to deliver a strong framework of quality and safety for mothers and babies in maternity care.

In 2008, Minister Roxon initiated the maternity services review headed by the Commonwealth Chief Nurse and Midwifery Officer, Rosemary Bryant. That review received over 900 submissions from various stakeholders, including health professionals, researchers, non-government organisations, representative organisations and individuals. The review found that many of the women who submitted their individual experiences noted the need for further models of midwifery care, while professional groups highlighted the importance of collaborative, multidisciplinary maternity care. In response to the review, the government announced $120.5 million worth of maternity measures in this year’s budget. The amendments proposed in the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and related bills are part of that important $120.5 million maternity reform package.

Under the proposed changes in the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 midwives and nurse practitioners will have an enhanced role in providing quality care to patients. The bill will amend the Health Insurance Act 1973 and the National Health Act 1953. These amendments aim to support greater choice of access to health services for Australians. In particular, the bill proposes to extend the Medicare Benefits Schedule, the MBS, and the Pharmaceutical Benefits Scheme, the PBS, to patients of appropriately qualified and experienced nurse practitioners and midwives, including diagnostic imaging, pathology services and appropriate referrals.

Under the Health Insurance Act, a participating nurse practitioner or a participating midwife will be able to provide or request particular medical services, while under the National Health Act an authorised nurse practitioner or midwife will be authorised to prescribe certain PBS medicines. New MBS items for services will be created for participating nurse practitioners and midwives working with doctors, including antenatal, birthing and postnatal care. Participating nurses and midwives will also be able to refer their patients to specialists or consulting physicians under the MBS.

The bill requires the nurse practitioner or midwife to be an eligible nurse practitioner or midwife. The core requirement to become an eligible nurse practitioner or midwife is registration. Further, to access the MBS and PBS arrangements, midwives and nurse practitioners will have to show that they have collaborative arrangements with hospitals and doctors. The bill seeks to add authorised midwives and nurses as a new prescriber group. The list of prescription medications under PBS that they can prescribe will be limited and will correspond with the experience and scope of the authorised midwife or nurse. Of course, the extension of responsibility will also be in accordance with the relevant state or territory legislation.

It is estimated that the measures in this bill are expected to have a total cost of $111.3 million over four years, including administrative costs both for the department and Medicare Australia, and will be available from 1 November 2010. The costs, however, will be far outweighed by the overall responsiveness and efficiency of the health workforce with the introduction of these measures. These measures recognise our highly skilled and capable nursing and midwifery workforce by expanding their roles. Many other countries have already benefited from such measures. The definition of nurse practitioners as outlined by the Australian Nursing and Midwifery Council is, in part:

A registered nurse, educated and authorised to function autonomously and collaboratively in an advanced and extended clinical role. The role includes assessment and management of clients, using nursing knowledge and skills and may include, but is not limited to the direct referral of patients to other health care professionals, prescribing medications and ordering diagnostic investigations.

The definition of a midwife is:

A person who has completed a prescribed course of studies in midwifery and is registered or legally licensed to practice midwifery.

The midwife is recognised as a responsible and accountable professional, who works in partnership with women to give necessary support, care and advice during pregnancy, labour and the postpartum period.

I would like to point out this afternoon that, while members of the opposition have also recognised the quality of care nurse practitioners and midwives provide our community, for 11 years their recognition never extended to the formal legislative measures contained in these bills. I think it is important to note in this debate that it is the government, not the opposition, that is actually supporting nurse practitioners and midwives through these bills. It is the government, not the opposition, proposing measures to highlight the important role they play in our community and offering patients improved access to their services. The Consumers Health Forum noted in Health Voices that the review’s recommendations would deliver a more people-centred, flexible, team-centred health system. A people-centred, flexible, team oriented health system will surely provide improved patient care. The government is listening to the Australian people and delivering on major reforms across the board, including reforms in health and ageing.

The Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 will provide a government supported insurance scheme for midwives. It is important to note at this stage that midwives have not been covered by any indemnity insurance since 2002. This bill allows the Commonwealth to provide affordable professional indemnity insurance to eligible privately practising midwives. Due to market failure it was impossible for privately practising midwives to secure indemnity insurance policies. This is another measure in the maternity reform package which improves access to midwifery services by extending indemnity insurance to eligible midwives. In 2008 the Council of Australian Governments agreed to establish a national registration and accreditation program for certain health professionals, and it is due to complete in July 2010. The main purpose of the scheme was to provide more flexible and accountable arrangements for health professionals including, but not exclusive to, those in midwifery and nursing. The first stage of the legislation was passed in 2008 and, after extensive consultation with stakeholders, the Australian Health Workforce Ministerial Council released the exposure draft of the second stage of the legislation. Under the proposed legislation, practitioners will be required to have ‘suitable professional indemnity insurance during the period of their registration’.

A government supported professional indemnity insurance scheme for those midwives will offer more midwifery services in rural and remote communities and more scholarships for general practitioners and midwives, as well as a 24- hour, seven-days-a-week telephone helpline and information service to provide greater access to maternity information and support before and after birth. These bills refer to the implementation of the first two items. Further to the midwife professional indemnity scheme, the government has proposed the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009 which will be offered to midwives who cease practice. Under the midwife professional indemnity scheme the insurance policy will cover, through a tax levy, future claims made against eligible midwives who leave the workforce. This measure provides extra protection to midwives for periods that they are non-practising. The two bills relating to indemnity for midwives are estimated to cost approximately $25.2 million over four years.

The opposition have taken issue with the proposed midwife professional indemnity scheme. However, they did nothing in government, as I said earlier, to improve the situation when private midwives, mothers and babies were left without indemnity insurance. This government aims to improve access and quality in our health system, and the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and related bills have received support from numerous stakeholders. The Maternity Coalition stated:

This is a historic breakthrough for Australia’s health care system. It promises to, over time, improve the accessibility, quality, safety and cost-effectiveness of Australia’s maternity services, by building a primary care foundation which is currently missing for most women.

While the legislation was welcomed by many groups, I acknowledge there is concern that the indemnity arrangements would effectively outlaw midwives assisting homebirth. In a recent meeting I had with a concerned mother and constituent, Robyn, she outlined the reasons why women choose homebirth and why it should continue without government restrictions—and I can understand that. In response to our meeting, Robyn put in writing to me her concerns and suggestions for midwives and homebirth and I would like to read out parts of her correspondence in this House today. She writes:

My main wish is at least to maintain the status quo. I want women to continue to be able to access homebirth with an independent midwife without this being unlawful or subject to $30 000 fines for consumers and midwives.

Robyn goes on to write:

It would be preferable for consumers and independent midwives to have access to indemnity insurance without that dictating a range of practice to the detriment of midwives’ informed professional opinion and women’s informed choices.

Robyn states that, ideally, homebirth should have equal access to funding and argues:

There is a growing set of evidence to support homebirth as a safe and arguably safer place for birth than hospital, there is a will within the government to reduce the burden on the hospital system and many women who would access homebirth if they could afford to.

Towards the end of her letter, my constituent states:

The loss of homebirth in this country would be a great loss for women who want natural style birth as well as those who want home birth.

One of Robyn’s requests to me is as follows:

Please call for any solution to recognise pregnant women’s autonomy as consumers with rights to informed choice, including informed refusal of hospitalisation.

I appreciate the concerns Robyn raised with me and I note that the minister responded to similar concerns by announcing last Friday, after consultation with the states and territories, that there will be a two-year exemption for homebirth midwives who are acting outside their state hospital system. I commend the minister for her swift and cooperative action with the state and territory health ministers on this issue. The exemption, however, does carry a number of conditions and requirements. The requirements include a number of reporting initiatives that will assist in accurate data collection. The data will provide further evidence based policy initiatives in the future. The reporting requirements may also highlight areas where further support could or should be given to midwives. It is important to reiterate that the minister’s priority is about seeking best possible patient outcomes.

This is another example of our government listening to the Australian people. Although homebirths account for approximately only a quarter of one per cent of all births in Australia, the choice of mothers concerning how to give birth and with whom is very important, and so is the paramount consideration of the safety of mother and child. Our government makes no secret of the fact that it endeavours to make our health system as efficient and effective as possible. That includes the significant investment in maternity care. Surely our health system, our maternity care framework, is worth this funding and investment proposed in these bills today.

Again I note that, since 2002, private midwives have not been insured. In a country as fortunate as ours, it is shameful that the opposition did nothing when in government to further assist midwives, particularly with indemnity insurance. It is a sad reflection of their dismissal of the important work of our midwives. The minister for health has announced a two-year exemption from indemnity insurance for private midwives. As I have previously stated, this will allow a closer examination of any possible alternative arrangements. However, it must remain that the health and safety of both mother and baby are paramount considerations in any decision. As stated by the minister, the government’s No. 1 priority is and always will be the improvement of patient outcomes.

The Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and related bills will be subject to agreement with states and territories on a national services plan, particularly the investment and provision of birthing centres and rural maternity units. The nurse practitioner reform will improve access to primary care services. Greater use of nurse practitioners will again help to improve the efficiency and effectiveness of the health services workforce. It is obvious that there are chronic shortages in areas of our health system, despite calls from the opposition that these measures are unnecessary. So it is hardly surprising that, after some 11 years of neglect, members of the opposition do not support measures that aim to improve the efficiency and effectiveness of our health system.

The proposed measures seek to improve productivity and harness the full capability of our well-trained nurses to complement and improve our health system. It is untrue to suggest that the measures seek to replace doctors and specialists. On the contrary—the measures will ensure collaboration between our health professionals. Nurse practitioners will be assigned roles comparable with qualifications and skills and will only enhance the quality of our health system, not endanger it. Proposed measures will require midwives to meet the eligibility requirements for both federal and state law.

In a media release dated 23 June 2009, the Australian Nursing Federation congratulated the government ‘for recognising the benefits that highly skilled and educated nurse practitioners and midwives bring to the health of all Australians’. Our government recognises the need for reform and recognises the need for improved access and choice in maternity care. I believe that this legislation has married very well the call for greater choice from mothers and the call for a more collaborative approach by the health professionals.

The bills before us today have been reviewed by a Senate inquiry. On 25 June this year the Senate referred the bills to the Community Affairs Legislation Committee for inquiry and report by 7 August 2009. The committee subsequently presented an interim report on 7 August and on 17 August tabled its final report. Our government proposed these measures after extensive consultation, and the committee obviously recognised the benefits provided within these provisions. The committee received almost 2,000 submissions, and the final report states in its conclusion:

The Committee welcomes the initiatives contained in the three bills. The recognition of the professional skills and expertise of nurse practitioners and midwives is a significant step. In particular, the changes to allow these two groups of professionals to access the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme will strengthen the health system and the delivery of maternity services in Australia.

Further, the recommendation reads:

The Committee recommends that 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 be passed.

In conclusion, the committee appreciates the benefits provided under these bills, and even members of the opposition have conceded the positive proposals for maternity care in these three related bills. The Rudd government appreciates that midwives play an important role in the births of many children and that, although a small percentage of women choose homebirthing, it is an important decision. The two-year exemption gives sufficient time for any further consideration and changes to be made. I trust that these bills and subsequent amendments will ensure that Australians continue to enjoy one of the world’s safest health systems for both mothers and their babies. I commend these bills to the House.