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Monday, 15 March 2010
Page: 1836


Senator IAN MACDONALD (8:36 PM) —I am indeed indebted to Senator Sterle for that very fine explanation 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 and all the issues surrounding them. I have known Senator Sterle as a very competent senator for Western Australia. His expertise in Transport Workers Union matters is without parallel. I had not realised that he was such an expert on midwifery and the issues before the chamber at the moment. In fact, he is such an expert that I would have almost thought he had written the speeches for the Minister for Health and Ageing, because his speech sounds very much like the minister’s written speech. If I were a cynic, which I am not, I would think that Senator Sterle’s speech, which he read every word of, was prepared by the minister or the minister’s department. But I am sure that is not right, because I know Senator Sterle is a very genuine representative for Western Australia. As I said, I was delighted to learn from what he read of every word of the speech he has just delivered for 20 minutes.

I do not come to this debate with any of that sort of expertise that Senator Sterle has shown. I wanted to speak tonight because, while I have to say it is not an area that I claim any expertise in at all, I was very impressed with the group of women in Townsville who came to see me and who explained this issue to me before I had really ever taken any interest in it. It probably does not need emphasising that I was someone who was not really terribly involved in this sort of policy issue. I said to them, ‘But wouldn’t you rather have your children in a hospital, where you have got immediate access to the very best of technical assistance, the very best of science, the very best medical expertise in the nurses and doctors and specialists all at hand?’ That seemed to me to be a common-sense provision. But after listening to these women—for about an hour, I think it was—I could understand their concerns at the legislation that the Labor government was bringing in. They had very real and genuine concerns. Apart from that, I have a concern about rural and regional Australia, and particularly northern remote Australia that I have some very great interest in. I just wonder where this legislation will leave people who are not very close to hospitals, to specialists and all that very best of attention. But I digress a little. I was very impressed with this group of women who came to see me in Townsville and the arguments they raised.

It has been the subject of great debate and in the end result the coalition has determined that the legislation is perhaps better than nothing. As colleagues have mentioned before, the coalition will not be opposing the passage of this bill. But I am concerned, and I readily understand the issues that this group of women who came to see me in Townsville have with this bill and with the general approach of the Labor Party to this issue. As I understand it, the government introduced legislation providing for MBS and PBS access for nurse practitioners and midwives to commence from 1 November 2010. The Commonwealth-subsidised indemnity insurance for midwives working in a collaborative setting is to commence on 1 July 2010. The legislation is in response to recommendations of the maternity services review. The indemnity insurance provisions will not, as I understand it, cover midwives providing birthing services outside of a clinical setting. I know that will be of great concern to many of my constituents who have spoken to me about this. The national registration and accreditation scheme will make indemnity insurance a mandatory requirement of registration as from 1 July this year. Therefore it will effectively be illegal for independent midwives to provide home birthing services from this date, and individuals who practise as midwives without registration face a maximum penalty of $30,000, in accordance with the exposure draft that came out in relation to the Health Practitioner Regulation National Law. Currently, as I understand it, insurers do not consider it viable to offer independent midwives indemnity insurance due to their small numbers and the lack of a risk profile. Women who have a home birth privately contracted with midwives without indemnity insurance, I can understand, have a great reason for concern.

Whilst we are in opposition and are powerless almost to get the right sort of legislation, this legislation, as I indicated, will not be opposed. But can I indicate that I am concerned for those who have a very genuine concern for having childbirth in the hospital systems and in what quite clearly the majority of Australians would consider is the right way to bring children into the world. But there are a very significant number of people who have very intense and well-grounded fears for the way that the state is, effectively, regulating what is their private lives.

I am also very concerned about the impact that this will have upon people living in remote and rural Australia. I often think that governments in Canberra and bureaucrats in Canberra do not really understand what life is like for admittedly a very small percentage of Australians. Indeed, they form a voting block which is of no significance whatsoever, but they are Australians and they deserve to be considered. I think it is very hard at times for ministers coming from capital cities to understand that there are places in Australia where you will drive eight hours to get to the closest hospital. You will wait for two days for the flying doctor service to come in and service your medical needs, including childbirth.

Legislation such as that we are dealing with today—and I think this is a very good example of this—really does not pay any attention to those Australians from remote and rural areas, who happily and stoically put up with their lot but who I think deserve some greater consideration. In the past they may have been able to give birth where they live, several hours from expert medical attention—when I say ‘expert’, sometimes they can get a midwife, and that is in my view expert medical attention; but in the common thinking they are remote from that—and they should have that option, they should have that choice. That is where I have some concerns with this bill.

I did not want to speak all that long on this. Earlier speakers from our side have indicated the coalition’s position, and have indicated very clearly the view that we take on this particular issue. Had we been in government we may have been taking a somewhat different approach. But I did want to speak in this debate to highlight the issues of those women who came to see me who very passionately believe in their right to give birth at home and to have the assistance, should they require it, of qualified midwives to help them with those births. I qualify my remarks by saying that this is not an area where I have any expertise—unlike Senator Sterle, who gave a very detailed and very keen explanation of the whole bill. Unusually for Senator Sterle, he read every single word of his speech; but, as I say, he clearly has a very keen and detailed interest in this. But I want to highlight the issues that have been made known to me and to indicate that, for the reasons my colleagues have pointed out, we will not be opposing the bill. I indicate in concluding that there are issues that I think do require further consideration by the government of the day.