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Tuesday, 8 September 2009
Page: 8954


Ms ROXON (Minister for Health and Ageing) (7:37 PM) —In summing up I want to thank the very large number of members of this House who have taken the time to contribute to the debate on these three bills. I think it is a measure of the community’s interest in midwifery and in changes to the workforce that allow recognition for midwives and nurse practitioners that we have heard so many members speaking on the bill, and I am very proud to be summing up the debate on these bills because they do introduce landmark changes for Australian nurses and midwives. This is something that for decades has been campaigned for. Under the long period of the previous government these pleas fell on deaf ears. It is a little surprising to hear contributions such as the one from the member for Indi, who never took any action as part of the government for 11 years to make any of these changes but is now demanding not only that these bills be introduced and these changes made but that every range of other issues that she thinks should now be raised must be delivered instantaneously by this government. It is pretty extraordinary that it has taken us until today to find out whether the Liberal Party would in fact support these important changes in the bill. I welcome and recognise that speakers today have acknowledged that the Liberal Party will belatedly, perhaps begrudgingly, support these bills. That is fantastic news for nurses, for midwives and for consumers across the country in our health system, which of course we all are at some point in our lives.

The bills enable patients of appropriately qualified and experienced midwives and nurse practitioners to access benefits under the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme, opening the way forward for improved access to maternity services, improved choice for women and improved access to services provided by nurse practitioners. For example, these bills will lead to better access to breastfeeding support for many thousands of women across the country. They will lead to better access to midwifery support during pregnancy, birth and the postnatal period. These bills will lead to better access to services for those hard to reach sections of our community such as those with mental illness, residents of our aged care facilities and Australians living in our rural and remote communities. Of course, they will not deliver all of the solutions to those people, but they will enhance the workforce response that can be provided to servicing those many people in our community who need and want the assistance of nurses and midwives.

Alongside the further development of secondary legislation there are a range of activities taking place which will enable these arrangements to be put in place and onto the Medicare Benefits Schedule by November 2010. This includes consultation on the detailed development of the new arrangements with professions and other key stakeholders, the conduct of a tender for a provider of indemnity insurance, and Medicare Australia systems development and the communications activities required to implement these reforms. To some listening, that might sound like a long period of time, but I can assure people that the introduction of new Medicare benefit items is always a slow process. When you are introducing items for an entirely new group of health professionals, and when an indemnity insurance product also needs to be established, this does take time.

After having listened to the debate over the last few days I think it is important to clarify some misconceptions about the effect of these bills, particularly on homebirth in Australia. The three bills before the House expand Commonwealth support for midwives and nurse practitioners in our community, as I have said, improving choice and extending Commonwealth funding for a range of midwife and nurse practitioner services for the first time ever. These three bills do not take away any current rights and none of these bills make homebirth unlawful. There is, however, a separate exposure draft bill for the national registration and accreditation scheme for health professionals. This bill is in exposure draft form, prepared for all jurisdictions via a COAG agreement, and is not yet before any parliament. The exposure draft of that separate bill currently carries a proposal that will require all registrants across 10 professions covered, including nurses and midwives, to carry insurance. This is an important part of raising the standards and providing public protection for patients and consumers across 10 different professions within the health sector. However, amongst those 10 professions, midwives are in a unique position because indemnity insurance has not been available for midwives operating outside public health services in Australia since 2002.

I might note in passing, given the animated way that a number of members opposite have contributed to this debate, that since 2002—which, if I recall correctly, was when the Howard government was in power—no action was ever taken by the previous government to rectify the absence of indemnity insurance for midwives. We, of course, through the introduction of these three bills, intend to change that. However, we were concerned that an unintended consequence of the requirement in the national registration and accreditation draft bill might be that homebirths would be driven underground. That is why I have been working for some months with the states and territories on the potential options to prevent this from happening. And, as I advised the House yesterday and am pleased to be able to advise again today, on Friday at the health ministers’ meeting, the meeting between the states, the territories and the Commonwealth, I was able to achieve the agreement of all health ministers around the country to a transitional clause in the current draft national registration and accreditation scheme legislation.

What this means is that a two-year exemption will last until June 2012 from the requirement to hold indemnity insurance for privately practising midwives who are unable to obtain professional indemnity insurance for attending a homebirth. In order to access this exemption, it will be a requirement for midwives attending homebirths to provide full disclosure to and receive informed consent from their patients that they do not have professional indemnity insurance. They will be required to report each homebirth and to participate in quality and safety frameworks, which will be developed after consultation, led by Victoria, through the finalisation and accreditation process. This has been achieved with all governments working together to obtain an outcome that is progressive for the sector but that will not make homebirths illegal. It is vital to emphasise a point—which I think the Liberal Party has now acknowledged—that to vote against this package of bills would prevent a major expansion of services to many hundreds of thousands of women and prevent establishment of any type of indemnity insurance for midwives. This is an outcome I know, from my meetings with many homebirth advocates, they would not want to see eventuate.

The government is committed to supporting Australia’s nurses and midwives, the backbone of our health workforce. The changes in these bills are significant and are a practical step in improving access and choice for Australians. I can indicate to the House that the government will not be supporting the second reading amendment moved by the member for Indi. We are very proud of the steps we are taking to expand and support services provided by midwives and nurse practitioners. We believe the agreement that has been reached with the states and territories ensures that no woman who chooses—with the proper information being provided to her—to birth at home will be disadvantaged. The current arrangements will continue. The support activities and care provided by the midwife at home—if a mother has chosen to have her child at home and has been properly informed that the activity will not be insured, as is currently the case—will not be able to be deregistered and will not be made unlawful.

I know there are people who would like this to be different and would like the government’s reforms to go even further. It is something that the Liberal Party has been arguing with passionate—although, I have to say, without much of a record to show that this is something they truly believe in, no action having been taken ever in the time that they were in government. We certainly understand that some people would like the legislation to go further. They would like us to provide not only MBS and PBS rights for midwives who are undertaking a whole range of services but who do not attend homebirths but insurance cover to homebirthing midwives as well. But that was not recommended to us as part of the maternity services review. We accept the advice provided to us as a result of the detailed process and review conducted by the National Chief Nursing and Midwifery Officer, Rosemary Bryant. Therefore, we will not be supporting the amendments that are moved and we remain extremely proud of the new choices we are providing for thousands of women across the country and of the midwives who want to provide care for these women and the nurse practitioners who will have access, for the first time ever, to MBS and PBS entitlements.


Mr Bruce Scott —The question is that the words proposed to be omitted stand part of the question. A division is required. In accordance with standing order 133 the division is deferred until 8 pm. The debate is therefore adjourned until that time.