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Wednesday, 23 October 2002
Page: 5740

Senator KNOWLES (4:03 PM) —Today we are debating whether or not midwives should be included in medical indemnity. It is interesting, because Senator Ridgeway has been offered, as recently as today, a full and comprehensive response from Senators Patterson and Coonan. He chose not to go down that path but to move this urgency motion today. I really have to question the motive as to why one would move a motion of this kind if one was seeking definite answers and definitive responses when that was offered but this course of action was preferred. Its just begs the question of whether or not we are wanting an answer or whether or not we are just wanting to grandstand. I fear now, having listened to the debate and having heard what has been said previously, that the grandstanding option is the course of action that is now being taken.

We need to understand that midwives actually fall into three employment groups: midwives who are employed by hospitals, agency midwives contracted to hospitals and independent, self-employed midwives. I do not think anybody would underestimate the role of many of the midwives. But one of the things that I think Australia has to come to grips with is whether the government now has to step in for every group of people and provide cover, insurance and backup. I think we are heading to a very dangerous course. I said to group of people who were in my office a few days ago that it is starting to worry me, with all of this insurance and with people now wanting government to take responsibility for their own actions, that government—and, thereby, the taxpayer, remembering that government does not have any money other than what the taxpayer gives it—is now becoming more of a hammock than a safety net. That worries me. I think the attitude of many people could certainly develop so that they could lie back and say: `It does not matter what happens; the taxpayer will pick up the tab. It doesn't matter, I don't have to cover myself; the taxpayer will pick up that tab as well.'

I think we should be looking at this under very different circumstances. Some of these midwives have got no coverage not because of any lack of government initiative but because insurance companies believe many of the midwives are a high risk. We also have to understand that the overwhelming majority of midwives are directly employed as employees of hospitals and are therefore covered under the professional indemnity arrangements of their employers.

I know that many good independent midwives are having difficulty obtaining professional indemnity insurance. But we need to understand that this is quite different from the situation doctors face, since doctors are able to obtain medical indemnity insurance cover. What I am trying to say is that it is because of the policies of the insurance companies that midwives have not got that cover, not because of some government policy that we are going to discriminate against all independent midwives and are not going to allow them to have indemnity cover. It is quite a different kettle of fish. The package announced today by the Prime Minister is designed, firstly, to address the financial viability of the providers of medical indemnity insurance and, secondly, to ensure that insurance cover for doctors remains affordable.

It is interesting that there is basically nothing the Commonwealth can do to force an insurer to cover certain people; it is the decision of an insurance company whether or not to cover those people. Dare I say that we have seen such decisions being taken by the insurance companies only in the last week and a half in relation to the tragic events in Bali. It was the insurance companies that made the decision to cover many of those who had policies that specifically excluded acts of terrorism. The government did not say to the insurance companies, `You must do X, Y and Z'; the decision was taken by the insurance companies. As I said, there is nothing the Commonwealth can do to force the insurance industry to provide insurance to this group of professionals, but it is interesting to note that the governments of my state of Western Australia and of the Australian Capital Territory have extended insurance coverage to independent midwives by effectively bringing them under the umbrella of government employment.

Senator McLucas —So governments can do something.

Senator KNOWLES —The state and territory governments can. The point Senator McLucas has just raised by way of interjection—that governments can do something— is a very good point because, based on what I was just saying, one could think that I meant all governments. What I am actually saying is that these people are working in the state and territory environment. They are working under state and territory auspices and they should be covered, if at all possible, under the umbrella of government employment in the states and territories. If Western Australia and the Australian Capital Territory can do that, I do not see any reason why the other states and the Northern Territory cannot do it as well. I encourage them to consider noting that they are responsible for the registration of midwives and for issues relating to midwives' professional standards. Therein lies the important distinction which Senator McLucas quite rightly raised: it is the states that are responsible for licensing and registration of midwives and it is the states that set their professional standards.

The Commonwealth has an important role in encouraging our state and territory counterparts to assist the midwifery work force in this way. The comprehensive package of measures announced today to address the financial viability of the providers of medical indemnity insurance and to ensure that insurance cover remains affordable for the doctors is important. But I say to honourable senators that we are heading down a dangerous path where everyone is wanting the taxpayers to pick up coverage as a matter of course instead of as a matter of last resort. There are many ways out of this other than trying to bring this very important group of professionals under the same umbrella as doctors when, in fact, the states and territories have the responsibility for registration and professional standards with regard to midwifery. I in no way wish to diminish the importance of the role of midwives and I in no way wish to diminish the importance of their indemnity. But I think it is important to understand that the Australian Institute of Health and Welfare figures indicate that 1.6 per cent of the midwifery work force is self-employed, while the claim by recruitment agencies to represent 25 per cent of the midwifery work force may to all intents and purposes be an overestimate.

The package of measures announced by the Prime Minister today does not address the indemnity arrangements for midwives as these are professional indemnity arrangements not covered by medical defence organisations. MDOs are mutual societies of doctors and so are separate from general insurers. I wish to make that point very clear. It is a very separate subject, and people who try to bring them under the same net are just trying to complicate the issue in an emotive way. They are saying that the government has to pick this up, when it should in fact be looking at the source of the problem and how it can be resolved instead of trying to bring the midwives into an area where responsibility for them does not lie. There has been a recently escalating media campaign by and on behalf of midwives in response to media reporting on the expected medical indemnity package, and I think that this debate is now part of that. If he had really wanted to try to resolve this issue, it would have been much more sensible of Senator Ridgeway to accept the offer of a full and comprehensive update and briefing.