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Monday, 15 March 2010
Page: 1832

Senator STERLE (8:18 PM) —I rise to comment on the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009, theMidwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009. These are particularly important and timely health bills and are a great credit to the Minister for Health and Ageing, the member for Gellibrand. I think this country is very fortunate to have such an outstanding minister. The measures contained in these bills are an essential step forward in the necessary reform of Australia’s health system. They will make lasting changes, for the better, in the way health services are delivered in this country. My only regret is that they could have come much sooner had it not been for the lack of effective action by the previous coalition government.

It is gross hypocrisy for opposition senators, including Senator Fierravanti-Wells, to come into this chamber and try to make out that they are the champions for the cause of private midwives and nurse practitioners when, for at least a decade, the coalition repeatedly failed to support, in any real and practical way, the very valuable roles carried out by nurse practitioners and private midwives. It has all gone quiet on the opposition side, Mr Acting Deputy President!

Measures contained in these bills will enable the implementation of the $120 million 2009-2010 budget commitment to improve choice of and access to maternity services. The maternity services reform package, made possible by this budget allocation, is the outcome of a very wide-ranging review of Australia’s maternity services. The 2009 Maternity Services Review, which was led by Rosemary Bryant, the Commonwealth Chief Nurse and Midwifery Officer, received over 900 submissions from a broad cross-section of stakeholders. Many of these submissions drew upon the personal experiences of women accessing available maternity services.

These bills will significantly improve maternity care options for women while ensuring that there is a strong framework of quality and safety for mothers and babies. The improved maternity service arrangements made possible by these bills should enable many more women to have access to maternity care closer to home.

Women who made submissions to the maternity services review were almost universally dissatisfied with the maternity care options available to them. In particular, they gave high priority to having access to midwifery models of care that were capable of and committed to providing continuity of maternity care from antenatal care, to birthing, through to postnatal care. The review found that too often the current system of maternity care was uncoordinated and, unfortunately, disjointed. The enhancement of the role of midwives that these bills will facilitate will ensure many more women will have the benefit of a coordinated care pathway from pregnancy through to professional postnatal care.

The measures contained in these bills are very much about promoting and enhancing multidisciplinary and professional collaboration in the provision of maternity care in Australia. The importance of collaborative multidisciplinary maternity care in order to ensure the delivery of high quality, safe and supported maternity care was confirmed by the various health professional groups.

This package of bills will enable eligible midwives to have access to the Medical Benefits Scheme and to the Pharmaceutical Benefits Scheme under appropriate arrangements. These arrangements include a requirement to work in collaborative arrangements with obstetricians and GP obstetricians. This requirement is an important practical aspect of a best practice multidisciplinary model of maternity care. It will foster and enhance the professional relationships that are essential in providing safe and high quality maternity care.

The minister has advised that at this stage it is not proposed to include home births in the new arrangements for midwives. The reason is that the maternity services review did not recommend that public funding should be provided for home birthing. Hence the government’s proposed professional indemnity insurance arrangements for private midwives do not include cover for attending home births. However, it also needs to be said that these bills do not take away any current rights in respect to home birthing.

It has been recognised, nonetheless, that there has been concern that the proposed national registration and accreditation for health professionals could make it unlawful for private midwives to practice without appropriate professional indemnity insurance. In this regard, the minister has advised that the planned national registration and accreditation legislation for health workers will include a transitional clause that will provide a two-year exemption, until 2012, from the requirement for privately practicing midwives who are unable to obtain professional indemnity insurance for attending a home birth to hold professional indemnity insurance. In order to access this exemption it will be a requirement for midwives attending homebirths to provide full disclosure to their clients that the midwife does not have professional indemnity insurance and to receive informed consent.

As well, midwives will be required to report each homebirth and to participate in safety frameworks which will be developed after consultation—led by consultation in Victoria. This measure will provide an added safeguard in ensuring the maintenance of high standards of quality and safety with regard to homebirths attended by nationally accredited midwives. In other words, the current arrangements will continue in respect to homebirths. If a mother has chosen to have a child at home and has been properly informed that the activity will not be insured, as is currently the case, the midwife will not be at risk of deregistration or penalty. It is important to note that this is no different to the situation that pertained during the period of the Howard government, except that there will be added quality and safety measures in respect to midwife attended home births.

I would now like to move on to discuss nurse practitioner reform measures that are contained in the proposed legislation. These measures will greatly enhance the role of nurse practitioners and their effectiveness in supporting essential primary care and other specialist nurse practitioner roles in the community. I believe that an enhanced role for nurse practitioners has the potential to greatly improve access to primary care services and to add significantly to the efficiency and effectiveness of primary care and chronic disease care in Australia.

The bottom line is that, unless we move to fully utilise the expertise and skills of our existing health workforce, Australia will face extreme difficulty in adequately meeting the health service needs of Australia’s growing and ageing population. It is important to note that nurse practitioners are by no means a new invention. They have been essential members of the health workforce of many OECD countries for many years. In fact, in some countries nurse practitioners have been in existence for over 40 years. Why then has Australia lagged so far behind the rest of the developed world with regard to nurse practitioners? The answer is simple: the medical profession, backed by the Liberal Party and the National Party, has persistently stymied an increased healthcare role for qualified nurse practitioners. The AMA is the greatest workplace turf protection outfit in this country, bar none. The turf war continues to this day even if it has become a little less overt.

For example, in respect to nurse practitioners, the AMA has not come up with a shred of credible evidence that the use of nurse practitioners in primary care lowers either access to or provision of high quality primary care. Too many doctors, egged on by the AMA’s closed shop specialists, remain antagonistic and suspicious of the concept of nurse practitioners. In this regard it is discouraging to find on the Australian Medical Association website an AMA position paper in respect to nurse practitioners which states:

The role of a nurse in the primary care setting does not include:

  • Formulating medical diagnosis
  • Referring patients to specialists
  • Independent ordering of pathology or radiology
  • Prescribing medication and issuing repeat prescriptions.

In other words, the official position of the AMA, as stated on its website, is to firmly ring fence anything that it regards as doctor territory regardless of benefit to patients or the health system. The AMA’s position statement with respect to nurse practitioners illustrates an even more important issue: namely, the poor record of the medical profession and its union—and they are a union, and a very powerful union; they do not like being called a union, but they are a union—to embrace the need for reform of the broader healthcare delivery model. The fact is that the inflexibility of politically powerful elements within the medical profession is harming the attainment of sustainable, efficient and high quality healthcare delivery for all Australians.

Maintaining entrenched regressive positions about the retention of turf rather than having regard to best practice healthcare delivery will in the end serve neither the interests of patients nor the interests of health providers. It is of meagre benefit to patients to be told that the quality of medical and health care provided in Australia stands alongside the best in the world if, when they need to access a healthcare service, they encounter significant and unnecessary obstacles to gaining access to needed health care. It has been recognised for well over a decade that Australia faces major challenges in maintaining and expanding its health workforce into the future. Australia’s health workforce is currently growing at approximately twice the rate of its total workforce growth. Already health workforce shortages are creating significant difficulties in meeting the medical and health service needs of a growing and ageing population. This is particularly so for people living in rural and remote areas and in the outer urban areas of Australia’s major cities. On current trends, the ability of Australia to maintain the current rate of health workforce growth seems, sadly, unlikely to be sustainable.

Hence it is necessary to ensure that Australia achieves maximum output and productivity from its existing health workforce. This will inevitably require changes to the structure of the health workforce and, where appropriate, to the roles of individual health workforce categories. The time has come when we cannot afford to have necessary health workforce reform stifled or stalled by vested interests of the various health occupations and health professional groups, particularly the Australian Medical Association. The fact is that many of the required reforms, such as an enhanced role for midwives and nurse practitioners, in reality are neither radical nor all that difficult to implement.

Australia has a nurse workforce of over 200,000 well-trained and well-educated nurses dedicated to professional excellence. Added to this, many nurses, through scholarship and personal initiative, have accumulated extensive experience in complex areas of healthcare delivery and hold postgraduate qualifications in their chosen health discipline and medical specialty. Certainly anyone who has had cause to attend a busy public hospital or who has witnessed the workload of a remote area nurse in, say, the north-west of Western Australia knows from direct personal observation the capabilities of nurses to deal with complex clinical situations. We need to ensure that our nurse workforce is able to continue to develop its skills and capacity to meet the complex healthcare service needs of Australia’s growing and ageing population. Access to required high-quality healthcare services is already a significant issue for Australia—for many people living in rural Australia, for people with mental illness and for many frail aged people. This situation will only get worse if we do not make better use of the skills and capabilities of our existing health workforce.

Members of the Howard government cannot claim to have been unaware of this problem. Senior health officials and planners have been drawing attention to Australia’s looming health workforce crisis for years. In 2005, at the request of the Howard government, the Productivity Commission undertook an extensive investigation into Australia’s health workforce issues. The Productivity Commission was requested:

… to undertake a research study to examine the issues impacting on the health workforce, including the supply of, and demand for, health workforce professionals, and proposed solutions to ensure the continued delivery of quality health care over the next 10 years.

The request to the Productivity Commission went on to say:

The study is to be undertaken in the context of the need for efficient and effective delivery of health services in an environment of demographic change, technological advances and rising health costs.

The Productivity Commission submitted its report to the government in December 2005. In its study the commission found:

… measures aimed at boosting the supply of health workers will not by themselves be sufficient to provide a sustainable solution to Australia’s health delivery needs. In particular, they will not address inefficient and inflexible workplace arrangements that reduce the productivity of the available workforce.

Even cursory reading of the commission’s report would leave most readers in little doubt that the latter comment concerning inefficient and inflexible workplace arrangements is largely directed at the tactics of the strongest occupational group in the country: the doctors and the doctors’ union—in other words, the AMA. It is an undeniable fact that, whereas most other occupations have had to adjust and accept wide-ranging workplace change in the cause of economic reform, the medical profession has been almost totally untouched by these events. The medical profession has been cocooned from workplace reform, and this is costing the taxpayer dearly as total healthcare costs continue to rise faster than the value of Australia’s GDP. This is unsustainable in the long term.

Finally, the measures in the proposed legislation of enabling eligible nurse practitioners to access the MBS and the PBS, to prescribe certain medicines and to have rights to refer to specialists is exactly the sort of critical action required to increase the efficiency and effectiveness of the available health workforce. These measures will significantly improve access to primary care services where there are shortages of medical practitioners and where timely access is too often problematic. The Minister for Health and Ageing and her department are to be congratulated on bringing forward these healthcare delivery changes. Not only are the changes urgently needed but also I am sure that they will be a huge success and will benefit thousands of Australians throughout the country. I commend the bills to the Senate.