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Monday, 15 March 2010
Page: 1848


Senator MOORE (9:34 PM) —This evening we are looking at three separate pieces of legislation, and they are all important in the evolution of our medical system. As has happened consistently from the time that the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 was brought forward, we have had a concentration of the discussion on the issue of homebirths. And while I, like everybody else in this debate seemingly, will talk about homebirth later in my contribution, I want to put on the record straight away that it is important that we know the legislation in front of us does not do anything to change the status of homebirth in this country. Despite the statements that have been made around the chamber this evening, it is important to know that the legislation which we are discussing this evening does not take away any current rights or make homebirth illegal or more difficult in this country. It is part of the process that we are discussing about the way a range of legislation will operate in our community into the future. However, I am disappointed that so many people throughout this debate have continued to create some kind of scare campaign and have not looked at what we are considering this evening. That does not make it any easier to make people in the wider community understand what exactly is going on.

What has happened with the legislation before us is that we now have a major breakthrough, a major move forward in the way that nurse practitioners and midwives will be treated in our health system from the end of June 2010. It is something that we need to think about because the discussion about the professional skills and the involvement of nurses in our health system is one that has been going on for many years. Through this legislation the government, our government, with the support of the opposition, has been able to say that with appropriate skills and training, with that recognised, and with the regulations imposed, we will be able to come back into this place, through disallowable instruments, and we will be able to allow practising midwives and practising nurse practitioners in our country to be able to use the PBS and the MBS systems most effectively in our health system.

This is a major achievement and one which has been celebrated and recognised by people across the country. Go to the evidence we received in the Senate Community Affairs Committee and note the pride with which so many people from the nursing professions were able to say that this is something for which they have been working and this is something which we have now achieved in our community for the first time. It acknowledges professional skill. It looks at the role that nurse practitioners and midwives can take in our wider health system. It does not create a two-tier health system, which is another scare tactic that has been used in this debate tonight. There is no attempt to create a two-tier health system in this country.

What we are doing is looking across the community, looking at what the available skills are and looking at the professionalism and the strong cooperative arrangements that are present to ensure that we have the best possible health system that reaches people across all our communities and in all parts of our country. This is not a contest between people with different sets of skills; it is a celebration of the different values of the skills and of using them together in our system. The passing, which I am very pleased to hear is going to occur, of the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 will achieve this outcome. That is one step along the road to an ever-evolving health system. But if we have people who are continuing, for whatever reason, to create conflict or to create contest then it will take away the value of the practitioners who are seeking to work. Encouraging our people, our nurse practitioners and our qualified midwives with advanced skills to use the PBS and MBS systems most effectively to ensure that they are able to prescribe medication appropriate to their skills area, to be able to refer appropriately according to their skills area and to work in cooperative arrangements with other professionals at all levels will create a stronger, more flexible and better health system for all of us.

Those opposite are trying to create some kind of scare that we are going to be trading skills off against each other and that some parts of the country will not be able to use or have access to particular professionals. That is just not true. What we have before us is a bill that ensures skills will be recognised, that people will be able to practise effectively for the betterment of all of us, that resources will be used more effectively and that we will be able to celebrate and collaborate together.

The Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009, which we are looking at tonight, is, again, something which is long overdue. Whilst I do acknowledge so many contributions in this debate that talk about why we need to move more quickly, why we should be including all aspects in tonight’s legislation and why we have failed to include homebirths in this process, I want to remind the people who are involved in this debate that midwives have been without effective professional insurance since 2002 in this country and there has been no effort made across this chamber to ensure that that is addressed. Through this legislation, there has been an attempt. There are some processes which need to be addressed. There needs to be much more discussion between the various groups involved in this process, including the professional groups and, most assuredly, the insurance industry.

Through this legislation, the threshold achievement has been reached, which allows practising midwives in this country to access professional medical insurance with government support, which has been lost in much of the debate that we have had up until this time. If you look at the history of medical indemnity insurance in this country, in 2001-02, when there were so many problems, the government stepped in to provide support for the medical profession. At that time there was no support for midwives in that process. They have been effectively operating without support since that time. This legislation addresses that. With people and the professional colleges working together, we will be able to ensure that there will be that protection for midwives.

We have heard before in this debate about the process around homebirths. I knew we would come to it because it took up a considerable part of all the debate that we had in the two Senate Community Affairs Committee inquiries that were formed around the legislation. When you have a look at the committee reports, while they were looking at three pieces of legislation, they seemed to be concentrating exclusively on the role of homebirth. It is an important fact that many women came to those inquiries and said that this was a choice they wanted to make.

It is also an important fact that people from the various parts of the medical professions—doctors, nurses and people who worked in the hospital system—also came forth and gave their ideas about how we should move effectively forward to ensure that we have the safest possible birthing arrangements for all women in this country. I applaud the fact that these people were able to come forward and talk together very openly about a shared interest—and there is a shared interest. Overwhelmingly, people talked to us consistently about the need for safety and security and the involvement of the people who choose to be involved, such as family and medical practitioners.

People talked about the fact that there needed to be cooperation and collaboration, a word which was used much and which I value. We have not formally been able to pull that completely together at this stage but we have a process for ensuring that does occur. It is something that has never happened before in this country. What we have, through the processes which the government has put together, is continuing work on the national registration scheme, which is bringing together the professional colleges to ensure appropriate registration for medical practitioners of all kinds in our community. We also have the ongoing work of the Victorian government, which is looking to put together a framework for professional practice and which will be able to show the effect of midwives and doctors working together to see how best that can be defined. That has been an agreed process and it has been a cooperative process.

The Maternity Services Advisory Group was formed to provide information to the government about the whole range of issues which we need to address on safe birthing in this country and it has been working extraordinarily hard for the last several months, once again, to come up with an agreed solution. That is what will be involved in the regulations, which will come back to this place as disallowable instruments, to put this in place.

There has not been any attempt to close down any of this debate. In fact, what the government has done is encourage it to occur, but for the last few years this particular process has not been in place. The legislation, through a combination of the NRAS—the National Registration and Accreditation Scheme—and this process, which is looking at professional indemnity for midwives and people who are working in the system, will be able to come up with the outcome which so many people have sought. Many people have given us evidence and put forward their views in the various Senate community affairs committees, and senators and members in this place have received many emails and contributions from people talking about their birthing rights.

We have heard the views of a number of senators tonight about what the future of this process should be. There must be an outcome. There is a genuine commitment from all the people who have been involved to ensure that there is an outcome. This particular legislation provides movement forward. It does not determine what the regulations are going to be; that will come back to this place. There is no way that there is going to be a disconnect between the regulations which support this legislation and the legislation which is before us this evening. Again, the role of the Senate will be to consider those regulations through the various processes, to ensure that they once again meet the needs of consumer groups, medical groups and of the government and funding groups. It is a simple stage of our medical process.

There continues to be genuine interest in this process, as there must be. We have a collaborative arrangement between the state governments and the federal government looking at how we can bring this to a conclusion through COAG, because so much of what happens in maternity services at this stage is the responsibility of state governments. I want to put on record this evening the amazing welcome and support that I had from a number of state hospitals in Queensland, when I visited their midwifery services to see how they operate. I want to congratulate and thank the staff members in the midwifery section of the Goondiwindi Hospital, where I spent many hours talking about the way midwifery services are operating in that place, and I saw a genuine collaborative service.

I also want to congratulate the number of people—particularly from the private midwives group—who have worked tirelessly to ensure that the needs of their members are met and are put into place in any legislation that comes forward. There is no doubt that there will be an outcome because there is so much goodwill and determination. It is not a competition or a conspiracy between different parts of the medical profession. Many people have moved a long way from when this debate began and I think that should be acknowledged. We have before us three pieces of legislation, none of which make anything that is happening illegal and all of which provide an incredible breakthrough for people with professional skills. So many people will benefit from now having greater access to professional skills in our hospitals and health system.