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Monday, 15 March 2010
Page: 1846


Senator FIELDING (Leader of the Family First Party) (9:26 PM) —I will speak generally on health to start with, as these bills are related to health, and then I will move directly on to the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and related bills. Australia has a health system that is on life support at the moment. We have a health system that is broken. Just months ago, we had a major report put out by the National Health and Hospitals Reform Commission which essentially said the same thing. The facts speak for themselves. There are nearly 90,000 patients on public surgery waiting lists. There are 70 per cent of emergency patients who are forced to spend more than eight hours waiting for a bed. The third point is that the average waiting time for elective surgery has increased in most states and is still a real concern.

I have lost count of the number of times that the Prime Minister and the Minister for Health and Ageing have been snapped by the cameras, yet there is still a massive shortage of doctors across the country, particularly in rural and regional areas. The Rudd government is actually going backwards, not forwards, when it comes to health. In 2007, the Labor Party went to the election promising Australians they would fix the healthcare system and would take it over by the middle of the year if it was still stuffed. Guess what? It is still stuffed. It cannot even get its health takeover right. The Rudd government’s plan for a federal takeover is half-baked. It is not a real takeover. It is just rearranging the deckchairs. The Rudd government has proposed a 60-40 funding split, which is a change from a 40-60 funding split. That is not a takeover; that is just rearranging the split between the federal government and the states. The Rudd government has once again overpromised and underdelivered when it comes to health.

The legislation before us now is, once again, proof of how the Rudd government has mismanaged the health system. The legislation contains some good initiatives but also contains some bandaid solutions to our massive health problems that the Rudd government just does not seem to want to address. The legislation before the parliament will see nurse practitioners prescribing pathology and referral rights almost equivalent to that of a GP. I am not against nurse practitioners, but what I am against is the Rudd government using these supernurses to deal with the fact that we do not have enough GPs. Before Family First kicked up a fuss that these supernurses were going to be allowed to operate without the supervision of a GP and without the need for any collaborative agreement with doctors’ clinics, nurse practitioners were going to be able to refer patients to specialists without having any involvement from GPs. Thankfully, common sense has now prevailed and the government has realised that this kind of health reform is only going to fragment the health services even further and end up costing the health system more because it will lead to multiple consultations and claims. The government has now backtracked on this and has put forward new amendments which will require nurses to enter into a collaborative agreement with a doctor’s clinic.

But despite introducing the requirement for collaborative agreements, there are still some issues with the approach which has been taken by the government to fixing the healthcare system. I am all for increasing the role of nurses in the healthcare system because they are highly skilled health professionals who are certainly capable of doing more in the primary health team. The expert knowledge and skill level of nurses is often underappreciated in our health system and it is good that we are looking to expand their role in the health system. But I have big concerns about what the government is looking to do—that is, to simply replace GPs with nurses, particularly in towns where there is a GP shortage. The solution to the massive doctor shortage is not to give nurses more responsibility; it is to train more doctors. It is plain and simple and I cannot understand why the government just is not getting the message.

No-one can replace the family GP who knows your history and your health issues. Unfortunately, the government is prescribing people living in the country a second-rate medical treatment. This plan will disadvantage towns in Victoria like Sale or Hamilton, where there are already GP shortages, because families will be forced to see a nurse instead of their family doctor, while their city counterparts can still get to their GP. This is going to create a huge disparity between the country and the city as to the standard of health care. Country people still deserve access to a doctor and the GP must remain the cornerstone of the primary health team and the first port of call for patients.

I want to also touch on another aspect of the bills where I have some real concerns. There is a big problem that needs to be fixed and that is in relation to the government’s treatment of homebirths. Until very recently, the Rudd government was committed to effectively banning homebirths in Australia altogether. The decision to ban homebirths went against all common sense. Under the government’s original plan, midwives were to be banned from assisting with homebirths and any midwife caught breaching the rules would be fined $30,000. The decision to ban homebirths was totally outrageous and was inconsistent with how the healthcare systems in all other parts of the world are allowed to operate. The decision to ban homebirths came out of left field and was without any justification whatsoever because it ran counter to the right of women to choose how they wish to give birth. It is just another example of how the Rudd government is treating Australians like children and trying to tell us what is best for us. It is not up to the government to tell women how or where to give birth; it is up to women to make a choice about this matter.

Numerous studies have shown that for low-risk women with appropriate transfer-to-hospital options available, homebirths are at least as safe as births in hospitals or birth centres. More recently, in April last year, a study comparing the relative safety of homebirths and hospital births found that there was no difference as to death or serious illness among either mothers or their babies. These facts demonstrate that there was never any good reason for the government to intervene and block the choice of women to deliver their babies in a home environment. After rallies outside the minister’s offices in Melbourne and in Canberra, the government was forced into yet another embarrassing backflip and announced that it would grant a two-year suspension to the ban on midwives attending homebirths. The government, with its tail wagging between its legs, was forced to basically admit that it had completely got it wrong and did not have a clue as to what was the best way forward.

The two-year exemption for midwives who attend homebirths is a short-term bandaid solution. The two-year exemption is a temporary measure that does not fix the problem that the government has created for itself. The two-year exemption is nothing more than a delay tactic to silence any critics so that the government can go to the next election pretending that it is doing something about the homebirth issue. The government has known for months about the problems with homebirths and now it claims that it needs two more years to fix the problem. Surely the government knows that Australians are smarter than that. Surely the government does not think that we were all born yesterday. The changes that the government has put forward are not good enough because they do not fix the issue once and for all, and it has had plenty of time to address the issue.

Family First are not interested in a temporary solution. We want a permanent solution that will make sure that women continue to have the right to give birth at home if they want. And what we certainly do not want is for doctors to have the right to veto midwives who want to attend homebirths by refusing to enter into a collaborative agreement with them. The only person that should have the right to decide whether or not they have a homebirth is the pregnant woman in consultation with the primary care people. This is an issue which needs to be addressed by the government and there is no reason why the government cannot maintain collaborative agreements with nurses while still fixing the homebirth issue. The government needs to stop playing games and demonstrate that it is serious about the homebirth issue by putting forward a solution that will solve the problem once and for all rather than deferring it with a bandaid solution.